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General NPI Number Information
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NPI Number | 1619944857
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Entity Type | Individual
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Provider Name | KIMBERLY MIDDLETON M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 4170 LAVON DR STE 146
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City | GARLAND
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State | TX
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Zip | 75040-2975
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Country | US
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Telephone | 972-495-7224
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Fax | 708-756-4026
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Provider Business Mailing Address
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Address Line | 4170 LAVON DR STE 146
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City | GARLAND
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State | TX
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Zip | 75040-2975
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Country | US
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Telephone | 972-495-7224
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Fax | 972-495-2224
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 036103921
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S4192
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License Number State | TX
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