Provider Demographics
NPI:1952344889
Name:KIMMITT, ELIZABETH S (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:S
Last Name:KIMMITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1050
Mailing Address - Country:US
Mailing Address - Phone:630-725-2730
Mailing Address - Fax:844-205-5691
Practice Address - Street 1:9515 DEERECO RD
Practice Address - Street 2:SUITE 205
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2116
Practice Address - Country:US
Practice Address - Phone:410-252-6836
Practice Address - Fax:410-252-6825
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0027824202K00000X, 207P00000X
PAMD065121L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD327741100Medicaid
DC000277D14Medicare PIN
MD327741100Medicaid
MDDO6229Medicare PIN
MDP00694729Medicare PIN
MDB70928Medicare UPIN