MEDICARE: KEVIN KIMM DO,PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1215972567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN KIMM DO,PC

Provider Business Mailing Address
First Line	:	621 S ILLINOIS AVE
Second Line	:	SUITE 103
City	:	MASON CITY
State	:	IA
Zip	:	50401-5489
Country	:	US
Telephone Number	:	641-494-3041
Fax Number	:	641-494-3059

Provider Business Practice Location Address
First Line	:	1010 S GRAND AVE
Second Line	:	SUITE 1
City	:	CHARLES CITY
State	:	IA
Zip	:	50616-3729
Country	:	US
Telephone Number	:	641-228-5555
Fax Number	:	641-228-5556

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. KEVIN KIMM
Credential	:	DO
Telephone Number	:	641-228-5555

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	08/22/2020

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