Provider Demographics
NPI:1265078620
Name:KIMBALL, ANGELA DENISE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25172 MAPLEBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5282
Mailing Address - Country:US
Mailing Address - Phone:248-678-1713
Mailing Address - Fax:248-809-3116
Practice Address - Street 1:25172 MAPLEBROOKE DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5282
Practice Address - Country:US
Practice Address - Phone:248-678-1713
Practice Address - Fax:248-809-3116
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health