Provider Demographics
NPI:1487819686
Name:AL-KIMAWI, MAGID AZAM (MD)
Entity Type:Individual
Prefix:
First Name:MAGID
Middle Name:AZAM
Last Name:AL-KIMAWI
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 1:1285 CREEKSIDE BLVD E UNIT 102
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0595
Mailing Address - Country:US
Mailing Address - Phone:239-624-0960
Mailing Address - Fax:239-624-0961
Practice Address - Street 1:1285 CREEKSIDE BLVD E UNIT 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0595
Practice Address - Country:US
Practice Address - Phone:239-624-0960
Practice Address - Fax:239-624-0961
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2018-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257452208100000X, 208VP0014X
FLME1379432081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100996100Medicaid
FLKI092OtherMEDICARE
FLBCJA4OtherBCBS