Basic Information
Provider Information | |||||||||
NPI: | 1457310351 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KIMZEY | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 829641 | ||||||||
Address2: |   | ||||||||
City: | PHILADELPHIA | ||||||||
State: | PA | ||||||||
PostalCode: | 191820001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2673705296 | ||||||||
FaxNumber: | 2152303725 | ||||||||
Practice Location | |||||||||
Address1: | 599 W STATE ST STE 205 | ||||||||
Address2: |   | ||||||||
City: | DOYLESTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 189012567 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2678806975 | ||||||||
FaxNumber: | 2678806981 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/20/2006 | ||||||||
LastUpdateDate: | 06/14/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | OS010118L | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | OS010118L | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.