Provider Demographics
NPI:1952491516
Name:STINE, KIMO C (MD)
Entity Type:Individual
Prefix:
First Name:KIMO
Middle Name:C
Last Name:STINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 CHILDRENS WAY # 653
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-4082
Practice Address - Street 1:1 CHILDRENS WAY # 512-10
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3500
Practice Address - Country:US
Practice Address - Phone:501-364-4374
Practice Address - Fax:501-364-6829
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2020-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARN-8125208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR120036001Medicaid
E07307Medicare UPIN