Provider Demographics
NPI:1831160316
Name:ALMODOVAR, KIM (MD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:ALMODOVAR
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 1:1460 WALTON BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1779
Mailing Address - Country:US
Mailing Address - Phone:248-656-4225
Mailing Address - Fax:248-656-4250
Practice Address - Street 1:1460 WALTON BLVD STE 209
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1779
Practice Address - Country:US
Practice Address - Phone:248-656-4225
Practice Address - Fax:248-656-4250
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1082207RG0100X
AZ63580207RG0100X
MI4301053408207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4149444Medicaid
MI0Q26284OtherBCBSM
MI0Q26284010Medicare ID - Type Unspecified
MI0Q26284OtherBCBSM