Basic Information
| Provider Information | |||||||||
| NPI: | 1518079623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUDSPETH | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9515 HOLY CROSS LN | ||||||||
| Address2: | |||||||||
| City: | BREESE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622303618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185264511 | ||||||||
| FaxNumber: | 6185264537 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 MUNSTER ST | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622451004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185234216 | ||||||||
| FaxNumber: | 6185237049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0431810 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036131870 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 04-31810 | KS | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 036131870 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.