Healthcare Provider Details

I. General information

NPI: 1740242890
Provider Name (Legal Business Name): RICHARD A KIMMELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N 2ND ST
CLINTON MO
64735-1192
US

IV. Provider business mailing address

PO BOX 699
SHAWNEE MISSION KS
66201-0699
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-6690
  • Fax: 660-885-8496
Mailing address:
  • Phone: 913-469-4244
  • Fax: 913-469-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number104043
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: