Healthcare Provider Details

I. General information

NPI: 1083176978
Provider Name (Legal Business Name): KIMBERLY BADDOURA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 SW 37TH AVE
COCONUT GROVE FL
33133-2728
US

IV. Provider business mailing address

580 CRANDON BLVD # 201
KEY BISCAYNE FL
33149-1832
US

V. Phone/Fax

Practice location:
  • Phone: 305-642-4263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME178943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: