=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316909278
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD D KIMMEL DO FCCP PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2006
-----------------------------------------------------
Last Update Date | 02/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9980 CENTRAL PARK BLVD N SUITE 316
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-1762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-477-0210
-----------------------------------------------------
Fax | 561-470-0198
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9980 CENTRAL PARK BLVD N SUITE 316
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33428-1762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-477-0210
-----------------------------------------------------
Fax | 561-470-0198
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | RICHARD D KIMMEL
-----------------------------------------------------
Credential | DO FCCP PA
-----------------------------------------------------
Telephone | 561-477-0210
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | OS 6191
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------