Provider Demographics
NPI:1457354888
Name:RAKES-STEPHENS, KIMBERLY D (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:D
Last Name:RAKES-STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:RAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:134 JUNGLE RD
Mailing Address - Street 2:
Mailing Address - City:EDISTO ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29438-3005
Mailing Address - Country:US
Mailing Address - Phone:843-217-1695
Mailing Address - Fax:844-299-7575
Practice Address - Street 1:134 JUNGLE RD
Practice Address - Street 2:
Practice Address - City:EDISTO ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29438-3005
Practice Address - Country:US
Practice Address - Phone:843-897-7757
Practice Address - Fax:843-897-7877
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17943207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC226954Medicaid
SCG499728580Medicare PIN
SC226954Medicaid
SCG499727924Medicare ID - Type UnspecifiedMEDICARE
SCG49972Medicare UPIN