MEDICARE: FLORENCE KIMBO M.D., LLC

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	2084P0804X	Child & Adolescent Psychiatry Physician	35085738	OH
2	164W00000X	Licensed Practical Nurse	COA12811	OH
3	1041C0700X	Clinical Social Worker	1000379	OH
4	2083B0002X	Obesity Medicine (Preventive Medicine) Physician
5	2084P0804X	Child & Adolescent Psychiatry Physician	35087776	OH
6	2084P0800X	Psychiatry Physician	35094183	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457788960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORENCE KIMBO M.D., LLC

Provider Business Mailing Address
First Line	:	18660 BAGLEY RD BLDG 1
Second Line	:	SUITE 404
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3483
Country	:	US
Telephone Number	:	440-234-8746
Fax Number	:

Provider Business Practice Location Address
First Line	:	7530 LUCERNE DR STE 110
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-6557
Country	:	US
Telephone Number	:	440-234-8746
Fax Number	:	440-234-8748

Authorized Official
Title or Position	:	OWNER
Name	:	FLORENCE V KIMBO
Credential	:
Telephone Number	:	440-234-8746

Provider Enumeration Date	:	09/28/2013
Last Update Date	:	06/15/2026

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Directions to “FLORENCE KIMBO M.D., LLC ” Practice Location

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