Individual
ELIZABETH L KIMBROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
491 S WASHBURN ST, SUITE 100, OSHKOSH, WI 54904-6733
(920) 292-5555
(920) 292-1717
Mailing address
3232 N BALLARD RD, APPLETON, APPLETON, WI 54911-8804
(920) 749-9668
(920) 734-5307
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
42248
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110232655
RAILROAD MEDICARE
WI
01
—
13124
DEAN
WI
05
—
33345700
—
WI
01
—
390807236YY
UNITY
WI
01
—
WI01A2
JOHN DEERE
WI
Enumeration date
12/13/2005
Last updated
07/21/2016
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