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General NPI Number Information
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NPI Number | 1013323096
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Entity Type | Individual
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Provider Name | KIMBERLY REMEDIOS-SMITH M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 2400 N ROCKTON AVE
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City | ROCKFORD
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State | IL
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Zip | 61103-3655
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Country | US
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Telephone | 815-971-5000
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Fax | 815-968-5742
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Provider Business Mailing Address
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Address Line | 4940 EASTERN AVE AA2-NICU; 2ND FL 299D
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City | BALTIMORE
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State | MD
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Zip | 21224-2735
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Country | US
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Telephone | 410-550-2461
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Fax | 410-550-1163
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | D0078130
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License Number State | MD
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