Provider Demographics
NPI:1528379567
Name:RADLOFF, KIMBERLY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:RADLOFF
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 1:106 SCOTT FARMS BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-7069
Mailing Address - Country:US
Mailing Address - Phone:937-738-7645
Mailing Address - Fax:937-738-7667
Practice Address - Street 1:106 SCOTT FARMS BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-7069
Practice Address - Country:US
Practice Address - Phone:937-738-7645
Practice Address - Fax:937-738-7667
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH123391207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology