Provider Demographics
NPI:1306833280
Name:GHUMAN, KIMBERLEY A (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:A
Last Name:GHUMAN
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9888
Mailing Address - Fax:239-424-4091
Practice Address - Street 1:650 DEL PRADO BLVD S STE 107
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-343-9888
Practice Address - Fax:239-424-4091
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0081195208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259788800Medicaid
FL51605ZMedicare PIN
FL370017876Medicare PIN