Provider Demographics
NPI:1265467096
Name:KIMBALL, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64-5188 KINOHOU ST
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8409
Mailing Address - Country:US
Mailing Address - Phone:808-887-0600
Mailing Address - Fax:808-887-6699
Practice Address - Street 1:64-5188 KINOHOU ST
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8409
Practice Address - Country:US
Practice Address - Phone:808-887-0600
Practice Address - Fax:808-887-6699
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8651207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI56531902Medicaid
HIH54720Medicare PIN
HI56531902Medicaid