Individual
LAWRENCE DUSTIN KIMBALL III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
451 HIDDEN MEADOWS DR, SUITE 120, HILLSDALE, MI 49242-9812
(517) 437-0010
(517) 437-0319
Mailing address
451 HIDDEN MEADOWS DR, SUITE 120, HILLSDALE, MI 49242-9812
(517) 437-0010
(517) 437-0319
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101010860
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0120040
PHP
MI
01
—
0153000035
BCBS
MI
01
—
080071137
MEDICARE-RAILROAD
MI
01
—
102060
GLHP
MI
05
—
2935031
—
MI
01
—
P89542
BCN
MI
Enumeration date
07/08/2005
Last updated
04/14/2014
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