Provider Demographics
NPI:1578573630
Name:BIMLE, CYNTHIA PETRUS (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:PETRUS
Last Name:BIMLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CINDY
Other - Middle Name:MARIE
Other - Last Name:BIMLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:107 CONTEMPO
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291
Mailing Address - Country:US
Mailing Address - Phone:318-388-5030
Mailing Address - Fax:
Practice Address - Street 1:107 CONTEMPO
Practice Address - Street 2:SUITE A
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-388-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12124R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1697117Medicaid
5Y725Medicare UPIN