Provider Demographics
NPI:1972567154
Name:HIMMEL, KENNETH S (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:S
Last Name:HIMMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:5757 HARPER DRIVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-888-5757
Practice Address - Fax:505-889-3589
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2008-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0146207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM001H33OtherBC BS OF NM
NMP00343296OtherRRB MEDICARE RAILROAD
AZ115638Medicaid
NM70308233Medicaid
NM343619501Medicare ID - Type Unspecified
H47840Medicare UPIN