Provider Demographics
NPI:1568618494
Name:KIMBERLY C BERNI MD LLC
Entity Type:Organization
Organization Name:KIMBERLY C BERNI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:CRAWFORD
Authorized Official - Last Name:BERNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-561-6710
Mailing Address - Street 1:10890 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1475
Mailing Address - Country:US
Mailing Address - Phone:636-561-6710
Mailing Address - Fax:636-625-1601
Practice Address - Street 1:10890 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1475
Practice Address - Country:US
Practice Address - Phone:636-561-6710
Practice Address - Fax:636-625-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103702208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty