Provider Demographics
NPI:1033283551
Name:WINSTON MATTHEWS, KIMBERLY M (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:WINSTON MATTHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:4401 CONNER
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48215
Mailing Address - Country:US
Mailing Address - Phone:313-823-9800
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:4401 CONNER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215
Practice Address - Country:US
Practice Address - Phone:313-823-9800
Practice Address - Fax:313-823-9883
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080H262390OtherBLUE CROSS-BLUE CROSS
KW063310OtherCHAMPUS-CHAMPUS
MI337843310Medicaid
KW063310OtherCOMMERCIAL-COMMERCIAL NUMBER