Provider Demographics
NPI:1437189883
Name:HAMILTON, KIMBERLY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:HAMILTON
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 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:375 BRIARWOOD CIR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1605
Practice Address - Country:US
Practice Address - Phone:734-998-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900523207R00000X, 207RR0500X
FLME138408207R00000X
PAMD417425207R00000X, 207RR0500X
MI4301508926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102476800Medicaid
FL7MO85OtherBCBS
PA7296450OtherAETNA
PA1519848OtherGATEWAY-WMG
MD611892OtherCAREFIRST MD BCBS
PA50065245OtherCAPITAL BLUE CROSS-WMG
PA71442OtherGEISINGER
PA20005823OtherAMERIHEALTH MERCY-WMG
PA001862496Medicaid
PA120189OtherUNISON-WMG
PA30684OtherJOHNS HOPKINS
PA30684OtherJOHNS HOPKINS
MD611892OtherCAREFIRST MD BCBS
PA1519848OtherGATEWAY-WMG