Provider Demographics
NPI:1386642270
Name:HUNKELE, KIMBERLY DAWN (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:HUNKELE
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 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:704-443-6250
Mailing Address - Fax:
Practice Address - Street 1:2030 WINDSOR RUN LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-0054
Practice Address - Country:US
Practice Address - Phone:704-443-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-00904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002501Medicaid
OH2341175Medicaid
OH2341175Medicaid
OHP00865224OtherRRMCR
WV3810002501Medicaid
WV3810002501Medicaid
OH4088955Medicare PIN
OH4088953Medicare PIN
OHP00865224OtherRRMCR