Provider Demographics
NPI:1932170362
Name:FUIKS, KIMBALL SANDS (MD)
Entity Type:Individual
Prefix:
First Name:KIMBALL
Middle Name:SANDS
Last Name:FUIKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17280 W NORTH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045
Mailing Address - Country:US
Mailing Address - Phone:262-784-4205
Mailing Address - Fax:262-784-6549
Practice Address - Street 1:17280 W NORTH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045
Practice Address - Country:US
Practice Address - Phone:262-784-4205
Practice Address - Fax:262-784-6549
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32726207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4581860001OtherMEDICARE DMERC PIN
WI31768900Medicaid
WI140007387OtherRAILROAD MEDICARE PIN
WI000001987Medicare PIN
WI000101987Medicare PIN
WI140007387OtherRAILROAD MEDICARE PIN
WI000138280Medicare PIN
WI31768900Medicaid
WI000038280Medicare PIN
WI4581860001Medicare NSC
WI000268219Medicare PIN
WI4581860001OtherMEDICARE DMERC PIN