Provider Demographics
NPI:1003806514
Name:KIMBALL, RONALD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:
Practice Address - Street 1:509 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-1645
Practice Address - Country:US
Practice Address - Phone:217-383-6636
Practice Address - Fax:217-383-3466
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45330207VX0201X
IL036128873207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO018061OtherKAISER COMMERCIAL NUMBER
CO52572731Medicaid
CO52572731Medicaid
CO018061OtherKAISER COMMERCIAL NUMBER
CAF25512Medicare UPIN