Provider Demographics
NPI:1952592123
Name:ALEX LIMA M.D, PC
Entity Type:Organization
Organization Name:ALEX LIMA M.D, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-772-1139
Mailing Address - Street 1:2834 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7401
Mailing Address - Country:US
Mailing Address - Phone:773-772-1139
Mailing Address - Fax:773-772-9260
Practice Address - Street 1:2834 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7401
Practice Address - Country:US
Practice Address - Phone:773-772-1139
Practice Address - Fax:773-772-9260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1637042OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL215472Medicare PIN