MEDICARE: DR. KIMBERLY KAYE OTTWELL M.D.

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
1	207Q00000X	Family Medicine Physician	20319	AZ

General Provider Information

NPI Number	:	1376645747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY KAYE OTTWELL M.D.

Provider Business Mailing Address
First Line	:	U.S. DEPARTMENT OF STATE M/MED/QI, SA-1
Second Line	:	KIMBERLY OTTWELL, MD
City	:	WASHINGTON
State	:	DC
Zip	:	20522-0102
Country	:	US
Telephone Number	:	202-663-2453
Fax Number	:	202-663-3247

Provider Business Practice Location Address
First Line	:	U.S. DEPARTMENT OF STATE M/MED/QI, SA-1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20522-0102
Country	:	US
Telephone Number	:	202-663-2453
Fax Number	:	202-663-3247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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