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NPI Code Detail

MEDICARE: IRENE KIMOVEC M.D

MEDICARE: IRENE KIMOVEC M.D
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
1207Q00000XFamily Medicine Physician4301048232MI

General Provider Information

NPI Number : 1851334254
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRENE KIMOVEC M.D
Provider Business Mailing Address
First Line : 30800 TELEGRAPH RD
Second Line : SUITE 3900
City : BINGHAM FARMS
State : MI
Zip : 48025-4542
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1915 N PERRY ST
Second Line :
City : PONTIAC
State : MI
Zip : 48340-2237
Country : US
Telephone Number : 248-276-3999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 08/15/2007

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Directions to “ IRENE KIMOVEC M.D” Practice Location

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