Provider Demographics
NPI:1831131580
Name:KIMM, KEVIN A (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:KIMM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:717 S STATE ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4469
Mailing Address - Country:US
Mailing Address - Phone:507-238-4949
Mailing Address - Fax:855-273-5489
Practice Address - Street 1:717 S STATE ST
Practice Address - Street 2:SUITE 900
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4469
Practice Address - Country:US
Practice Address - Phone:507-238-4949
Practice Address - Fax:855-273-5489
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-10-16
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Provider Licenses
StateLicense IDTaxonomies
MN50882207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400176790Medicare PIN