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NPI Code Detail

MEDICARE: KIM M STOOKE M.D.

MEDICARE: KIM M STOOKE 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 Physician35.088838OH
2207Q00000XFamily Medicine Physician18455WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922001767
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM M STOOKE M.D.
Provider Business Mailing Address
First Line : 800 GRAND CENTRAL MALL
Second Line : SUITE 4
City : VIENNA
State : WV
Zip : 26105-4131
Country : US
Telephone Number : 304-485-3300
Fax Number : 304-485-3317
Provider Business Practice Location Address
First Line : 800 GRAND CENTRAL MALL
Second Line : SUITE 4
City : VIENNA
State : WV
Zip : 26105-4131
Country : US
Telephone Number : 304-485-3300
Fax Number : 304-485-3317
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 09/15/2022

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Directions to “ KIM M STOOKE M.D.” Practice Location

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