Provider Demographics
NPI:1457356370
Name:KIMBALL, CATHERINE MILLIKEN (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MILLIKEN
Last Name:KIMBALL
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 1:180 KENNEDY MEMORIAL DR
Mailing Address - Street 2:STE 301
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4541
Mailing Address - Country:US
Mailing Address - Phone:207-873-3753
Mailing Address - Fax:207-873-2620
Practice Address - Street 1:180 KENNEDY MEMORIAL DR
Practice Address - Street 2:STE 301
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4541
Practice Address - Country:US
Practice Address - Phone:207-873-3753
Practice Address - Fax:207-873-2620
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME127010099Medicaid
ME127010099Medicaid
MESX0192Medicare PIN