Provider Demographics
NPI:1699842310
Name:ALBRIDGE, KIM MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:MICHELLE
Last Name:ALBRIDGE
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:109 WARREN ST STE 1
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916-3082
Practice Address - Country:US
Practice Address - Phone:920-885-2622
Practice Address - Fax:920-885-4419
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73598-20207N00000X
CAG72020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G301080Medicaid
070011419OtherRAILROAD MEDICARE
F78094Medicare UPIN
CA00G301080Medicaid