Provider Demographics
NPI:1528220365
Name:GUO, KIMBERLY X (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:X
Last Name:GUO
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 1:2150 MARBLE CLIFF OFFICE PARK STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1056
Mailing Address - Country:US
Mailing Address - Phone:614-627-1640
Mailing Address - Fax:614-299-6054
Practice Address - Street 1:2150 MARBLE CLIFF OFFICE PARK STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1056
Practice Address - Country:US
Practice Address - Phone:614-627-1640
Practice Address - Fax:614-299-6054
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.123013207R00000X
MI4301096606208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics