Provider Demographics
NPI:1104005917
Name:KIMBERLY A PUMMILL MD PC
Entity Type:Organization
Organization Name:KIMBERLY A PUMMILL MD PC
Other - Org Name:GRAND BLANC PLASTIC SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PUMMILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-606-7888
Mailing Address - Street 1:3595 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7335
Mailing Address - Country:US
Mailing Address - Phone:810-606-7888
Mailing Address - Fax:
Practice Address - Street 1:3595 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7335
Practice Address - Country:US
Practice Address - Phone:810-606-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070280174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0993473OtherHEALTH PLUS
7319368OtherAETNA
MI0251130OtherBLUE CROSS
14465OtherMCARE
6U4349OtherHAP
MI0993473OtherHEALTH PLUS