Provider Demographics
NPI:1760089171
Name:MAKI, KIMBERLY J (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:MAKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 WILSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:OH
Mailing Address - Zip Code:45122-9482
Mailing Address - Country:US
Mailing Address - Phone:513-767-4889
Mailing Address - Fax:
Practice Address - Street 1:2330 WILSHIRE CIR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:OH
Practice Address - Zip Code:45122-9482
Practice Address - Country:US
Practice Address - Phone:513-767-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care