Healthcare Provider Details

I. General information

NPI: 1780644138
Provider Name (Legal Business Name): KIMBERLY STONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10705 W PEORIA AVE
SUN CITY AZ
85351-4061
US

IV. Provider business mailing address

PO BOX 746093
ATLANTA GA
30374-6093
US

V. Phone/Fax

Practice location:
  • Phone: 623-259-6749
  • Fax:
Mailing address:
  • Phone: 773-352-1517
  • Fax: 312-929-0373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27668
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: