Provider Demographics
NPI:1538272661
Name:LIM, JOEL D (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:317-274-1201
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:317-274-1201
Practice Address - Fax:317-278-9905
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN010564332080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000321536OtherANTHEM-DEAC-350593390
IN200427830Medicaid
MO207483603Medicaid
350593390-042OtherTRICARE-DEAC-350593390
KY64063696Medicaid
MO207483603Medicaid
000000321536OtherANTHEM-DEAC-350593390
H86707Medicare UPIN