Provider Demographics
NPI:1780693150
Name:LIM, ROGER G (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:G
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 EAST RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-365-4119
Mailing Address - Fax:
Practice Address - Street 1:1905 HUEBBE PKWY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1842
Practice Address - Country:US
Practice Address - Phone:608-364-2293
Practice Address - Fax:608-364-2700
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18096020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
10650OtherDEAN HEALTH PLAN HMO
WI31187700Medicaid
10650OtherDEAN HEALTH PLAN HMO
WIB54588Medicare UPIN