Basic Information
| Provider Information | |||||||||
| NPI: | 1831160944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2734 W 87TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606523937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739184700 | ||||||||
| FaxNumber: | 3056986536 | ||||||||
| Practice Location | |||||||||
| Address1: | 2734 W 87TH ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739184700 | ||||||||
| FaxNumber: | 3056986536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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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 | 036098631 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036098631 | 05 | IL | MEDICAID |