MEDICARE: DR. KIMBERLY SUE MONTILEAUX DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	151	SD

General Provider Information

NPI Number	:	1508831389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY SUE MONTILEAUX DPM

Provider Business Mailing Address
First Line	:	PO BOX 540
Second Line	:
City	:	KYLE
State	:	SD
Zip	:	57752-0540
Country	:	US
Telephone Number	:	605-455-8211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CLINIC DR
Second Line	:
City	:	KYLE
State	:	SD
Zip	:	57752
Country	:	US
Telephone Number	:	605-455-8211
Fax Number	:

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	05/22/2012

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