Individual
KIMBERLY KAY WALLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1414 W FAIR AVE STE 285, MARQUETTE, MI 49855-5406
(906) 226-4618
Mailing address
325 E H ST, IRON MOUNTAIN, MI 49801-4760
(906) 774-3300
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
5101014957
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4785309
—
MI
01
—
P00260303
RAILROAD MEDICARE
MI
Enumeration date
11/28/2005
Last updated
12/10/2018
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