Individual
DR. KIMBERLY ELISE PORTALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1 SAINT ELIZABETH BLVD, O FALLON, IL 62269-1099
(618) 234-2120
Mailing address
1 SAINT ELIZABETH BLVD, O FALLON, IL 62269-1099
(618) 234-2120
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
20A13356
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/19/2012
Last updated
07/02/2024
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