MEDICARE: KIMBERLY S BEREBITSKY M.D.

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	207R00000X	Internal Medicine Physician	01057099A	IN
2	207N00000X	Dermatology Physician	01057099A	IN

General Provider Information

NPI Number	:	1215917950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY S BEREBITSKY M.D.

Provider Business Mailing Address
First Line	:	111 NEW HAMPSHIRE AVE STE 2
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-2864
Country	:	US
Telephone Number	:	330-947-6021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 SOUTHFIELD DR STE 1240
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-4499
Country	:	US
Telephone Number	:	317-838-9911
Fax Number	:	317-837-6080

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/16/2025

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