Individual
CUSTODIO L. LIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2235 WABASH AVE, TERRE HAUTE, IN 47807-3330
(812) 234-5273
(812) 232-4714
Mailing address
2235 WABASH AVE, TERRE HAUTE, IN 47807-3330
(812) 234-5273
(812) 232-4714
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01035522
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087131
BC/BS PROVIDER NO.
IN
05
—
100251710A
—
IN
Enumeration date
08/16/2005
Last updated
09/15/2017
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