Provider Demographics
NPI:1245223833
Name:BADER, KIMBERLY A (MD)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:BADER
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 1:2600 E SOUTHERN AVE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7745
Mailing Address - Country:US
Mailing Address - Phone:480-827-5265
Mailing Address - Fax:480-684-6603
Practice Address - Street 1:2600 E SOUTHERN AVE
Practice Address - Street 2:SUITE B2
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7745
Practice Address - Country:US
Practice Address - Phone:480-827-5265
Practice Address - Fax:480-684-6603
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34858207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ985020-01Medicaid
H58215Medicare UPIN
AZZ107112Medicare PIN
AZ985020-01Medicaid