MEDICARE: DR. BRIAN B KIMMEL DO

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	OS005625L	PA
2	311Z00000X	Custodial Care Facility	OS-005625L	PA

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	:	1528007176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN B KIMMEL DO

Provider Business Mailing Address
First Line	:	4517 E THOMPSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19137-2003
Country	:	US
Telephone Number	:	215-535-1275
Fax Number	:	215-535-8690

Provider Business Practice Location Address
First Line	:	4517 E THOMPSON ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19137-2003
Country	:	US
Telephone Number	:	215-535-1275
Fax Number	:	215-535-8690

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/23/2013

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