Provider Demographics
NPI:1548235856
Name:LIM, BERNARD B (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:B
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 1:2300 N EDWARD ST STE 2400
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-2400
Mailing Address - Fax:217-876-2405
Practice Address - Street 1:2300 N EDWARD ST STE 2400
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4163
Practice Address - Country:US
Practice Address - Phone:217-876-2400
Practice Address - Fax:217-876-2405
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.124105207RC0000X, 207RC0000X
IL036124105207RC0001X, 207RC0001X
WI69234207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124105Medicaid
IL036124105Medicaid
IAENROLLEDMedicaid
MNP00617230OtherRAILROAD MEDICARE
I40564Medicare UPIN
IAENROLLEDMedicaid
IL036124105Medicaid