Provider Demographics
NPI:1720042674
Name:KIMELMAN, JOEL P (DO)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:P
Last Name:KIMELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 LENNON ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1015
Mailing Address - Country:US
Mailing Address - Phone:810-732-1919
Mailing Address - Fax:810-732-3740
Practice Address - Street 1:3346 LENNON ROAD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1015
Practice Address - Country:US
Practice Address - Phone:810-732-1919
Practice Address - Fax:810-732-3740
Is Sole Proprietor?:No
Enumeration Date:2006-04-15
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJK0059032085R0202X
MI51010059032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4398860Medicaid
MI4477536OtherAETNA
MI57100OtherOMNICARE
MI016618OtherMIDWEST HEALTH PLANS
MI136504OtherGREAT LAKES HEALTH PLAN
MI300Q264480OtherBCBSM/BCN
MI136504OtherGREAT LAKES HEALTH PLAN
MI57100OtherOMNICARE