MEDICARE: DR. MICHAEL L. KIMBAROW PH.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	235Z00000X	Speech-Language Pathologist	11612	CA

General Provider Information

NPI Number	:	1467455733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL L. KIMBAROW PH.D.

Provider Business Mailing Address
First Line	:	3409 ALLISON CT
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-3953
Country	:	US
Telephone Number	:	650-572-1494
Fax Number	:	650-345-5860

Provider Business Practice Location Address
First Line	:	3409 ALLISON CT
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94403-3953
Country	:	US
Telephone Number	:	650-572-1494
Fax Number	:	650-345-5860

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. MICHAEL L. KIMBAROW PH.D.” Practice Location

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