MEDICARE: DR. ANTHONY EDWARD KIMBALL DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0655	AZ

General Provider Information

NPI Number	:	1871712273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY EDWARD KIMBALL DPM

Provider Business Mailing Address
First Line	:	5656 S POWER RD
Second Line	:	SUITE 124
City	:	HIGLEY
State	:	AZ
Zip	:	85236-5421
Country	:	US
Telephone Number	:	480-840-3457
Fax Number	:	480-840-3458

Provider Business Practice Location Address
First Line	:	5656 S POWER RD
Second Line	:	SUITE 124
City	:	HIGLEY
State	:	AZ
Zip	:	85236-5421
Country	:	US
Telephone Number	:	480-840-3457
Fax Number	:	480-840-3458

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	12/01/2021

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