Individual
DR. PAUL DAVIS KIMBRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
29350 SOUTHFIELD RD, SOUTHFIELD, MI 48076-2011
(248) 647-9790
Mailing address
735 JOHN R RD STE 150, TROY, MI 48083-5859
(248) 588-9300
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901004778
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12602113
CAQH
MI
05
—
1407296593
—
MI
Enumeration date
07/03/2013
Last updated
09/12/2019
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