Provider Demographics
NPI:1699733402
Name:KIMA, MARIE ALIXE (MD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ALIXE
Last Name:KIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NW 43RD ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6125
Mailing Address - Country:US
Mailing Address - Phone:352-378-9100
Mailing Address - Fax:352-378-9005
Practice Address - Street 1:500 NW 43RD ST
Practice Address - Street 2:SUITE#1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6125
Practice Address - Country:US
Practice Address - Phone:352-378-9100
Practice Address - Fax:352-378-9005
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME79445207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49970OtherBLUE CROSS AND BLUE SHIEL
FL257987100Medicaid
FL440003789OtherRAILROAD MEDICARE
FL257987100Medicaid
FLE3725WMedicare PIN