Provider Demographics
NPI:1033159900
Name:HART, KIMBERLY B (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:HART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:GEISZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:248-937-3602
Mailing Address - Fax:248-937-5819
Practice Address - Street 1:HURON VALLEY-SINAI HOSPITAL
Practice Address - Street 2:ONE WILLIAM CARLS DR
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382
Practice Address - Country:US
Practice Address - Phone:248-937-3602
Practice Address - Fax:248-937-5819
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010614472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P30630258Medicare PIN