Provider Demographics
NPI:1679511224
Name:KIMMELCARE FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:KIMMELCARE FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:321-757-0600
Mailing Address - Street 1:2230 N WICKHAM RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:321-757-0600
Mailing Address - Fax:321-757-0690
Practice Address - Street 1:2230 N WICKHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-757-0600
Practice Address - Fax:321-757-0690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379144100Medicaid
FL2001160OtherAETNA HMO
FL4847751001OtherCIGNA
FL57253OtherBCBS
FL02131OtherUNIVERSAL HEALTHCARE
FL27886OtherWELLCARE STAYWELL
FL5619422OtherAETNA PPO
G20329Medicare UPIN