Provider Demographics
NPI:1124098116
Name:STRAUB, KIMBERLY S (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:STRAUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1320 W CLAIREMONT AVE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4566
Mailing Address - Country:US
Mailing Address - Phone:715-834-1555
Mailing Address - Fax:715-835-0263
Practice Address - Street 1:1320 W CLAIREMONT AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4566
Practice Address - Country:US
Practice Address - Phone:715-834-1555
Practice Address - Fax:715-835-0263
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI52895-20207Q00000X, 208M00000X
MN38926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45236Medicare UPIN