Provider Demographics
NPI:1588648653
Name:KIMBALL, MICHAEL PATTON (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PATTON
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9333 GENESEE AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2103
Mailing Address - Country:US
Mailing Address - Phone:858-455-6460
Mailing Address - Fax:858-455-7197
Practice Address - Street 1:9333 GENESEE AVE STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2103
Practice Address - Country:US
Practice Address - Phone:858-455-6460
Practice Address - Fax:858-455-7197
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2024-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG76060207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC07800Medicare UPIN
CA0443010001Medicare NSC