Provider Demographics
NPI:1851388714
Name:ROYAL, KIMBERLY SUE (DO)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SUE
Last Name:ROYAL
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:PO BOX 72098
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:513-557-3195
Mailing Address - Fax:513-557-3347
Practice Address - Street 1:2111 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3547
Practice Address - Country:US
Practice Address - Phone:419-281-5575
Practice Address - Fax:419-289-5584
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2053709Medicaid
OH2053709Medicaid
OHP00663546Medicare PIN
OHRO0830402Medicare PIN
OH2053709Medicaid