Provider Demographics
NPI:1992750384
Name:CRUTE, KIMBERLY A (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:CRUTE
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 1:836 E 65TH ST STE 22
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4493
Mailing Address - Country:US
Mailing Address - Phone:912-819-7171
Mailing Address - Fax:912-691-9287
Practice Address - Street 1:5354 REYNOLDS ST STE 422
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6011
Practice Address - Country:US
Practice Address - Phone:912-354-2634
Practice Address - Fax:912-354-8375
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86726207V00000X
GA050954207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000948098EMedicaid
GA349741OtherWELLCARE
SCG50954Medicaid
GA10063676OtherAMERIGROUP
GA624519OtherWELLCARE
GAP00080837OtherRR MEDICARE
GA52005412-004OtherBCBSGA
GA000948098AMedicaid
GA16BBBRNMedicare PIN
GA52005412-004OtherBCBSGA