Provider Demographics
NPI:1114972361
Name:MARIE ALIXE KIMA
Entity Type:Organization
Organization Name:MARIE ALIXE KIMA
Other - Org Name:INFECTION PREVENTION AND TREATMENT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:ALIXE
Authorized Official - Last Name:KIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-378-9100
Mailing Address - Street 1:500 NW 43RD STREET SUITE #1
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607
Mailing Address - Country:US
Mailing Address - Phone:352-378-9100
Mailing Address - Fax:352-378-9005
Practice Address - Street 1:500 NW 43RD STREET SUITE #1
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-378-9100
Practice Address - Fax:352-378-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79445207RI0200X
FL207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002138800Medicaid
FLDN7443OtherRAILROAD MEDICARE
FL000MDOtherFL BLUE SHIELD
FLE3725WMedicare UPIN
FL000MDOtherFL BLUE SHIELD