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NPI Code Detail

MEDICARE: MICHAEL KIM

MEDICARE:   MICHAEL  KIM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist16268040WI

General Provider Information

NPI Number : 1306123989
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL KIM
Provider Business Mailing Address
First Line : 1400 E BRADY ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-1615
Country : US
Telephone Number : 414-272-2171
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E BRADY ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-1615
Country : US
Telephone Number : 414-272-2171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2011
Last Update Date : 02/16/2012

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Directions to “ MICHAEL KIM ” Practice Location

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