Provider Demographics
NPI:1396933677
Name:KIMBERLY ROYAL, DO
Entity type:Organization
Organization Name:KIMBERLY ROYAL, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OSTEOPATHIC MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYAL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-289-6357
Mailing Address - Street 1:PO BOX 72098
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44192-0002
Mailing Address - Country:US
Mailing Address - Phone:513-557-3195
Mailing Address - Fax:513-557-3347
Practice Address - Street 1:1941 BANEY RD S
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-4502
Practice Address - Country:US
Practice Address - Phone:419-289-6357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6532207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH282-68-4616OtherBWC
OH2053709Medicaid
OHP00663546Medicare PIN
OH2053709Medicaid