Healthcare Provider Details

I. General information

NPI: 1457788960
Provider Name (Legal Business Name): FLORENCE KIMBO M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY RD BLDG 1 SUITE 404
CLEVELAND OH
44130-3483
US

IV. Provider business mailing address

18660 BAGLEY RD BLDG 1 SUITE 404
CLEVELAND OH
44130-3483
US

V. Phone/Fax

Practice location:
  • Phone: 440-234-8746
  • Fax:
Mailing address:
  • Phone: 440-234-8746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1000379
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35085738
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35087776
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberCOA12811
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35094183
License Number StateOH

VIII. Authorized Official

Name: FLORENCE V KIMBO
Title or Position: OWNER
Credential:
Phone: 440-234-8746