Provider Demographics
NPI:1609817527
Name:PUMMILL, KIMBERLY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:PUMMILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8384 HOLLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1976
Mailing Address - Country:US
Mailing Address - Phone:810-606-7888
Mailing Address - Fax:810-606-6864
Practice Address - Street 1:8384 HOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7335
Practice Address - Country:US
Practice Address - Phone:810-606-7888
Practice Address - Fax:810-606-6864
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301070280208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0251130OtherBLUE CROSS/BLUE SHIELD
MI14465OtherMCARE
MI6U4349OtherHAP
MI4469908Medicaid
MI0P13640OtherMEDICARE GROUP PTAN
MI300073509OtherCOMMERCIAL INSURANCE
MI0993473OtherHEALTHPLUS
MI4469908Medicaid