Provider Demographics
NPI:1134249444
Name:KIMMEL, MURRAY A (DO)
Entity type:Individual
Prefix:
First Name:MURRAY
Middle Name:A
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 N WICKHAM RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:321-757-0600
Mailing Address - Fax:321-757-0690
Practice Address - Street 1:2230 N WICKHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-757-0600
Practice Address - Fax:321-757-0690
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02131OtherUNIVERSAL HEALTHCARE
FL379144100Medicaid
FL57253OtherBCBS
FL2001160OtherAETNA HMO
FL5619422OtherAETNA PPO
FL112282200Medicaid
FL27886OtherWELLCARE
FL4847751003OtherCIGNA
FL57253OtherBCBS