Healthcare Provider Details

I. General information

NPI: 1164422622
Provider Name (Legal Business Name): KIMBERLY ANNE MOLIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST
SPRINGFIELD IL
62702-5324
US

IV. Provider business mailing address

800 E CARPENTER ST
SPRINGFIELD IL
62702-5324
US

V. Phone/Fax

Practice location:
  • Phone: 217-757-6535
  • Fax: 217-757-6536
Mailing address:
  • Phone: 217-757-6535
  • Fax: 217-757-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036136401
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number036136401
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: