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General NPI Number Information
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NPI Number | 1679511224
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Entity Type | Organization
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Legal Business Name | KIMMELCARE FAMILY PRACTICE PA
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 2230 N WICKHAM RD SUITE B
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City | MELBOURNE
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State | FL
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Zip | 32935
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Country | US
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Telephone | 321-757-0600
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Fax | 321-757-0690
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Provider Business Mailing Address
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Address Line | 2230 N WICKHAM RD SUITE B
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City | MELBOURNE
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State | FL
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Zip | 32935
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Country | US
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Telephone | 321-757-0600
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Fax | 321-757-0690
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Authorized Official
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Title or Position | PRESIDENT
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Name | MURRAY A KIMMEL
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Credential | DO
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Telephone | 321-757-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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