Provider Demographics
NPI:1962629915
Name:MCGLOTHAN, KIM RUDOLPH (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:RUDOLPH
Last Name:MCGLOTHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:LA'CHET
Other - Last Name:RUDOLPH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4760 WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3065
Mailing Address - Country:US
Mailing Address - Phone:334-288-0814
Mailing Address - Fax:334-288-3417
Practice Address - Street 1:4760 WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3065
Practice Address - Country:US
Practice Address - Phone:334-288-0814
Practice Address - Fax:334-288-3417
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31714207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology