Healthcare Provider Details

I. General information

NPI: 1952344889
Provider Name (Legal Business Name): ELIZABETH S KIMMITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 DEERECO RD SUITE 205
TIMONIUM MD
21093-2116
US

IV. Provider business mailing address

2001 BUTTERFIELD RD SUITE 300
DOWNERS GROVE IL
60515-1050
US

V. Phone/Fax

Practice location:
  • Phone: 410-252-6836
  • Fax: 410-252-6825
Mailing address:
  • Phone: 630-725-2730
  • Fax: 844-205-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0027824
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD065121L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberD0027824
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: