Healthcare Provider Details

I. General information

NPI: 1245309996
Provider Name (Legal Business Name): KIMBERLY ANN DOPPELT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY KELLER

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LAKESHORE DR # 108
ISHPEMING MI
49849-1367
US

IV. Provider business mailing address

901 LAKESHORE DR # 108
ISHPEMING MI
49849-1367
US

V. Phone/Fax

Practice location:
  • Phone: 906-485-2747
  • Fax:
Mailing address:
  • Phone: 906-485-2747
  • Fax: 906-485-2732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: