Provider Demographics
NPI:1104876432
Name:TONEY, KIMBERLY ARETHA (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ARETHA
Last Name:TONEY
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 1:9308 S VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7453
Mailing Address - Country:US
Mailing Address - Phone:773-278-5126
Mailing Address - Fax:773-409-1902
Practice Address - Street 1:7731 S HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-2412
Practice Address - Country:US
Practice Address - Phone:773-962-3705
Practice Address - Fax:773-962-3703
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103429Medicaid
H52294Medicare UPIN