MEDICARE: KIMBERLEE M PARKS P.A.

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	363AS0400X	Surgical Physician Assistant	5601005833	MI

General Provider Information

NPI Number	:	1639485527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEE M PARKS P.A.

Provider Business Mailing Address
First Line	:	850 W BARAGA AVE STE 20
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-4550
Country	:	US
Telephone Number	:	906-449-3440
Fax Number	:	833-916-2326

Provider Business Practice Location Address
First Line	:	850 W BARAGA AVE STE 20
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-4550
Country	:	US
Telephone Number	:	906-449-3440
Fax Number	:	833-916-2326

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

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	05/21/2026

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Directions to “ KIMBERLEE M PARKS P.A.” Practice Location

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