Provider Demographics
NPI:1700299468
Name:MANEK, KIMBERLY S (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:S
Last Name:MANEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 ROBERTS DRIVE
Mailing Address - Street 2:SUITE #323
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-241-9975
Mailing Address - Fax:904-249-3636
Practice Address - Street 1:1577 ROBERTS DR STE 323
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3266
Practice Address - Country:US
Practice Address - Phone:904-241-9775
Practice Address - Fax:904-249-3638
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127104207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology