Provider Demographics
NPI:1568408086
Name:RIGBY, KIM NOVAK (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:NOVAK
Last Name:RIGBY
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 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-519-7190
Mailing Address - Fax:801-535-7112
Practice Address - Street 1:525 E 1ST S
Practice Address - Street 2:#500
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-4210
Practice Address - Country:US
Practice Address - Phone:801-519-7190
Practice Address - Fax:801-535-7112
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2696291205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942854058520Medicaid
UT942854058520Medicaid
UT000063602Medicare PIN
UTC63907Medicare UPIN