Provider Demographics
NPI:1104966423
Name:MAGUIRE, KIM MARIE (MD, MPT)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARIE
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MD, MPT
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:PLUMITALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:6901 SIMMONS LOOP FL MS 80664
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-9498
Practice Address - Country:US
Practice Address - Phone:813-321-6237
Practice Address - Fax:813-463-1801
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117844207R00000X, 208M00000X
FLPT19643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14V1JOtherBLUE CROSS BLUE SHIELD
FL012647200Medicaid
FL887985100Medicaid
FL012647200Medicaid