Individual
MARK KIMBOROWICZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7350 INDUSTRIAL PARK BLVD, MENTOR, OH 44060-5318
(216) 732-9480
Mailing address
7350 INDUSTRIAL PARK BLVD, MENTOR, OH 44060-5318
(216) 732-9480
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
35047626K
OH
208D00000X
General Practice Physician
Primary
35.047626
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0493201
—
OH
01
—
930000109
MEDICARE RR-GA
OH
01
—
942460636194
CARESOURCE
OH
Enumeration date
06/08/2006
Last updated
03/17/2018
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