Provider Demographics
NPI:1336201334
Name:TOGLIATTI-TRICKETT, KIMBERLY ANN (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:TOGLIATTI-TRICKETT
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:PO BOX 31174
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-0174
Mailing Address - Country:US
Mailing Address - Phone:440-845-5055
Mailing Address - Fax:440-845-5054
Practice Address - Street 1:7900 VICTORIA CIR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-4891
Practice Address - Country:US
Practice Address - Phone:440-845-5055
Practice Address - Fax:440-845-5054
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-2965-T2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2361260Medicaid
OH4060902Medicare ID - Type Unspecified
OH2361260Medicaid
OH4828270001Medicare NSC