Provider Demographics
NPI:1972227924
Name:BAKER, KIMBERLY MICHELLE
Entity type:Individual
Prefix:MISS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 BOULTIER ST APT 205
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2230
Mailing Address - Country:US
Mailing Address - Phone:205-370-4834
Mailing Address - Fax:
Practice Address - Street 1:2727 BOULTIER ST APT 205
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2230
Practice Address - Country:US
Practice Address - Phone:205-370-4834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00000207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine