Provider Demographics
NPI:1497726707
Name:GUELDE, KIMBERLI J (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLI
Middle Name:J
Last Name:GUELDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIMBERLI
Other - Middle Name:J
Other - Last Name:HILEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1107 S DIVISION AVE
Mailing Address - Street 2:KSB MEDICAL GROUP
Mailing Address - City:POLO
Mailing Address - State:IL
Mailing Address - Zip Code:61064-1875
Mailing Address - Country:US
Mailing Address - Phone:815-946-3453
Mailing Address - Fax:815-946-3908
Practice Address - Street 1:1107 S DIVISION AVE
Practice Address - Street 2:KSB MEDICAL GROUP
Practice Address - City:POLO
Practice Address - State:IL
Practice Address - Zip Code:61064-1875
Practice Address - Country:US
Practice Address - Phone:815-946-3453
Practice Address - Fax:815-946-3908
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108558Medicaid
H86317Medicare UPIN
IL036108558Medicaid