Individual
DR. KIMBERLY L. MICUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
120 HILLCREST MEDICAL BLVD, SUITE 300, WACO, TX 76712-8948
(254) 313-6500
(254) 313-6599
Mailing address
1600 PROVIDENCE DR, WACO, TX 76707-2261
(254) 313-4200
(254) 313-4549
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
K2963
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0370389-01
—
TX
05
—
037038904
—
TX
01
—
160050362
RR/MEDICARE
TX
01
—
80314N
BLUE SHIELD
TX
Enumeration date
03/27/2006
Last updated
01/18/2017
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