Basic Information
| Provider Information | |||||||||
| NPI: | 1568521011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCORD | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 948, LOBBY J | ||||||||
| Address2: | 24 FRANK LLOYD WRIGHT DR. | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481060446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347476766 | ||||||||
| FaxNumber: | 7342223100 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 S. CANTON CENTER ROAD | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343987880 | ||||||||
| FaxNumber: | 7347617318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 12/09/2013 | ||||||||
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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 | 4301072761 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 43-01-072761 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.