Provider Demographics
NPI:1720236680
Name:ALT, KIM LE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LE
Last Name:ALT
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 1:120 MARCELL DR NE STE C
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1362
Mailing Address - Country:US
Mailing Address - Phone:616-259-6100
Mailing Address - Fax:
Practice Address - Street 1:120 MARCELL DR NE STE C
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1362
Practice Address - Country:US
Practice Address - Phone:616-259-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102481208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics