MEDICARE: KIMBERLY ANN GUSH 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	208000000X	Pediatrics Physician	2005-00670	NC

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

General Provider Information

NPI Number	:	1306845565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN GUSH M.D.

Provider Business Mailing Address
First Line	:	300 MARKET ST STE 112
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-4493
Country	:	US
Telephone Number	:	919-969-9611
Fax Number	:	919-969-9615

Provider Business Practice Location Address
First Line	:	300 MARKET ST STE 112
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-4493
Country	:	US
Telephone Number	:	919-969-9611
Fax Number	:	919-969-9615

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/09/2007

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