MEDICARE: DR. KIMBERLY SHIPMAN 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	207Q00000X	Family Medicine Physician	AZ45097	AZ

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	AZ45097	OTHER	AZ	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1376707471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY SHIPMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 746093
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6093
Country	:	US
Telephone Number	:	773-759-7550
Fax Number	:	312-929-0373

Provider Business Practice Location Address
First Line	:	3833 E THOMAS RD STE A2
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-7523
Country	:	US
Telephone Number	:	602-671-7066
Fax Number	:

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

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	02/03/2023

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