Provider Demographics
NPI:1356600787
Name:GYGI, KIMBERLY CHRISTINE (DO)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CHRISTINE
Last Name:GYGI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 MARSHALL PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2108
Mailing Address - Country:US
Mailing Address - Phone:860-683-0756
Mailing Address - Fax:
Practice Address - Street 1:851 MARSHALL PHELPS RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2108
Practice Address - Country:US
Practice Address - Phone:860-683-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019795207Q00000X, 390200000X
CT054177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program