MEDICARE: KIM ALMODOVAR 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	207RG0100X	Gastroenterology Physician	63580	AZ
2	207RG0100X	Gastroenterology Physician	4301053408	MI
3	207RG0100X	Gastroenterology Physician	1082	WI
4	207R00000X	Internal Medicine Physician	65385	TN
5	207RG0100X	Gastroenterology Physician	65385	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0Q26284	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831160316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM ALMODOVAR MD

Provider Business Mailing Address
First Line	:	1460 WALTON BLVD STE 209
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1779
Country	:	US
Telephone Number	:	248-656-4225
Fax Number	:	248-656-4250

Provider Business Practice Location Address
First Line	:	1460 WALTON BLVD STE 209
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-1779
Country	:	US
Telephone Number	:	248-656-4225
Fax Number	:	248-656-4250

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	08/05/2025

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Directions to “ KIM ALMODOVAR MD” Practice Location

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