Provider Demographics
NPI:1932427606
Name:KIMMERLE, CARLTON ROSS (MD)
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:ROSS
Last Name:KIMMERLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 PHALEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-2400
Practice Address - Country:US
Practice Address - Phone:651-495-6200
Practice Address - Fax:952-883-9738
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2021-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN580852081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine