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Organization
KIMBERLY GRILL DO P L C
Active
Organization
KIMBERLY GRILL DO P L C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY GRILL (OWNER)
(727) 545-4700
Entity
Organization
Contact information
Practice address
5425 PARK ST N, SUITE 5 W, ST PETERSBURG, FL 33709-7062
(727) 545-4700
Mailing address
1 MARYLAND FARMS, SUITE 200, BRENTWOOD, TN 37027-5006
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56-25888726
TAX ID NUMBER
FL
Enumeration date
02/15/2007
Last updated
12/31/2013
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