Provider Demographics
NPI:1184614265
Name:DOVIN, KIMBERLY ANNE (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:DOVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:894 CAMPUS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1644
Mailing Address - Country:US
Mailing Address - Phone:906-483-1445
Mailing Address - Fax:906-483-1122
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:SUITE 3
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1452
Practice Address - Country:US
Practice Address - Phone:906-483-1050
Practice Address - Fax:906-483-1270
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4632918Medicaid
MI233857Medicare ID - Type UnspecifiedRURAL HEALTH MEDICARE NUM
MI4632918Medicaid
MI080C160340Medicare ID - Type Unspecified