Provider Demographics
NPI:1609209063
Name:CORRIEA, KIMBERLEY (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:CORRIEA
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 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:561-863-5757
Mailing Address - Fax:561-863-6627
Practice Address - Street 1:2939 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-2916
Practice Address - Country:US
Practice Address - Phone:561-863-5757
Practice Address - Fax:561-863-6627
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134230208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102208100Medicaid