Provider Demographics
NPI:1174876585
Name:LIM, JUSTINE (PA)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 ROUTE 47
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-8107
Mailing Address - Country:US
Mailing Address - Phone:630-466-6000
Mailing Address - Fax:630-466-6001
Practice Address - Street 1:472 ROUTE 47
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-8107
Practice Address - Country:US
Practice Address - Phone:630-466-6000
Practice Address - Fax:630-466-6001
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5262207P00000X, 363A00000X
IL085009244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine