MEDICARE: ELIZABETH L KIMBROUGH MD

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	207R00000X	Internal Medicine Physician	42248	WI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	110232655	OTHER	WI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13124	OTHER	WI	DEAN
2	WI01A2	OTHER	WI	JOHN DEERE
4	390807236YY	OTHER	WI	UNITY
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750366704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH L KIMBROUGH MD

Provider Business Mailing Address
First Line	:	3232 N BALLARD RD
Second Line	:	APPLETON
City	:	APPLETON
State	:	WI
Zip	:	54911-8804
Country	:	US
Telephone Number	:	920-749-9668
Fax Number	:	920-734-5307

Provider Business Practice Location Address
First Line	:	491 S WASHBURN ST
Second Line	:	SUITE 100
City	:	OSHKOSH
State	:	WI
Zip	:	54904-6733
Country	:	US
Telephone Number	:	920-292-5555
Fax Number	:	920-292-1717

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/21/2016

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Directions to “ ELIZABETH L KIMBROUGH MD” Practice Location

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