Provider Demographics
NPI:1164430138
Name:ZIMLICH, KIMBERLY S (MD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:S
Last Name:ZIMLICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 WINGO WAY
Mailing Address - Street 2:STE 101
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-881-2484
Mailing Address - Fax:843-881-2909
Practice Address - Street 1:309 WINGO WAY
Practice Address - Street 2:STE 101
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-881-2484
Practice Address - Fax:843-881-2909
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC168366208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC168366Medicaid
G01757Medicare UPIN