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Individual

KIMBERLY SUMISLAWSKI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
680 N LAKE SHORE DR, CHICAGO, IL 60611-4546
(312) 695-6868
Mailing address
36416 SCOTTSMOUR CT, AVON, OH 44011-3461
(440) 522-5002

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
APP-000216482
OH

Other

Enumeration date
12/27/2018
Last updated
09/14/2019
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