1457356370 NPI number — CATHERINE MILLIKEN KIMBALL DO

Table of content: CATHERINE MILLIKEN KIMBALL DO (NPI 1457356370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457356370 NPI number — CATHERINE MILLIKEN KIMBALL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIMBALL
Provider First Name:
CATHERINE
Provider Middle Name:
MILLIKEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457356370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 KENNEDY MEMORIAL DR
Provider Second Line Business Mailing Address:
STE 301
Provider Business Mailing Address City Name:
WATERVILLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04901-4541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-873-3753
Provider Business Mailing Address Fax Number:
207-873-2620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 KENNEDY MEMORIAL DR
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901-4541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-873-3753
Provider Business Practice Location Address Fax Number:
207-873-2620
Provider Enumeration Date:
06/16/2005

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: 207Q00000X , with the licence number:  1175 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 127010099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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