Provider Demographics
NPI:1659335305
Name:NORRIS, KIMBERLY J (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:NORRIS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1761 W M-43 HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-8378
Mailing Address - Country:US
Mailing Address - Phone:269-945-3888
Mailing Address - Fax:269-945-2112
Practice Address - Street 1:1761 W M-43 HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-8378
Practice Address - Country:US
Practice Address - Phone:269-945-3888
Practice Address - Fax:269-945-2112
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2016-12-09
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Provider Licenses
StateLicense IDTaxonomies
MI43010539029207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2692416Medicaid
MID81788Medicare UPIN
MIP04740004Medicare PIN