Individual
KIMBERLY HOLLANDSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11100 EUCLID AVENUE, CLEVELAND, OH 44106
(216) 844-8200
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
35068570
OH
207ND0900X
Dermatopathology Physician
Primary
35068570
OH
207ZD0900X
Dermatopathology (Pathology) Physician
35068570
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221128
UNISON
OH
01
—
000000523163
ANTHEM
OH
05
—
0177955
—
OH
01
—
363644
WELLCARE
OH
01
—
5342550
AETNA
OH
01
—
606201
BUCKEYE
—
Enumeration date
12/14/2005
Last updated
07/05/2011
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