1144223801 NPI number — KIMBERLY A KOLAR M.D.

Table of content: KIMBERLY A KOLAR M.D. (NPI 1144223801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144223801 NPI number — KIMBERLY A KOLAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLAR
Provider First Name:
KIMBERLY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOLAR
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144223801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3950 G.S. RICHARDS BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARSON CITY
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89703-8457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-324-0699
Provider Business Mailing Address Fax Number:
775-888-8067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
640 W MOANA LN
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89509-4857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-324-0699
Provider Business Practice Location Address Fax Number:
775-888-8067
Provider Enumeration Date:
05/24/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  8012 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)