Provider Demographics
NPI:1972539328
Name:GLOYSTEIN, KIM JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:JEFFREY
Last Name:GLOYSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 FREMONT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3398
Mailing Address - Country:US
Mailing Address - Phone:269-969-6123
Mailing Address - Fax:269-969-6122
Practice Address - Street 1:363 FREMONT ST STE 203
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3398
Practice Address - Country:US
Practice Address - Phone:269-969-6123
Practice Address - Fax:269-969-6122
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10/3236278Medicaid
MI1417961137OtherBCBSM - BRONSON VICKSBURG OUTPATIENT CENTER
MI0C960650OtherBCBSM
MI1972539328Medicaid
MI1417961137OtherBCBSM - BRONSON VICKSBURG OUTPATIENT CENTER
MIC97618233 - BMHMedicare PIN
MIC96065018Medicare PIN
MI0C960650OtherBCBSM