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General NPI Number Information
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NPI Number | 1700892148
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Entity Type | Individual
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Provider Name | STEPHEN G. KIMMEL MD
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 01/25/2022
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Provider Practice Location Address
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Address Line | 450 W MEDICAL CENTER BLVD SUITE 600C
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City | WEBSTER
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State | TX
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Zip | 77598-4234
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Country | US
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Telephone | 281-554-1690
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Fax | 281-316-0590
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Provider Business Mailing Address
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Address Line | NEMOURS CHILDREN&APOS S CLINIC P.O. BOX 409992
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City | ATLANTA
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State | GA
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Zip | 30384-0001
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Country | US
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Telephone | 904-390-3610
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Fax | 904-288-5890
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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 | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | ME90982
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License Number State | FL
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