MEDICARE: DR. BARRY PAUL KIMBERLEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	28948	MN
2	207YS0012X	Sleep Medicine (Otolaryngology) Physician	28948	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063417012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY PAUL KIMBERLEY MD

Provider Business Mailing Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:	SUITE 230
City	:	NEWTON
State	:	KS
Zip	:	67114-7808
Country	:	US
Telephone Number	:	316-283-2828
Fax Number	:	316-283-2830

Provider Business Practice Location Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:	SUITE 230
City	:	NEWTON
State	:	KS
Zip	:	67114-7808
Country	:	US
Telephone Number	:	316-283-2828
Fax Number	:	316-283-2830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	09/25/2012

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