Individual
KIMBERLY WILTROUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-8735
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
2020008135
MO
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
287832
MA
Other
Enumeration date
06/12/2015
Last updated
02/01/2022
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