Healthcare Provider Details

I. General information

NPI: 1477607182
Provider Name (Legal Business Name): KIMBERLEY OLIVER ARDM, RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLEY ELLEN BUNESS

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 W ANN ARBOR TRL STE.200
PLYMOUTH MI
48170-1631
US

IV. Provider business mailing address

15418 OCEANA AVE
ALLEN PARK MI
48101-1956
US

V. Phone/Fax

Practice location:
  • Phone: 734-414-7056
  • Fax:
Mailing address:
  • Phone: 313-386-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number8566
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: