Azelton, Kimberly Rose

Azelton, Kimberly Rose is an individual health care provider with primary practice located at 714 N Michigan St , South Bend IN 46601-1035. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Azelton, Kimberly Rose can be contacted via phone (574) 647-7477.

Contact Information

Primary practice address
714 N Michigan St South Bend IN 46601-1035
Phone: (574) 647-7477
Fax: (574) 647-3655
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01084056A Indiana

Profile Details

NPI number 1972038594
LBN Legal business name Azelton, Kimberly Rose
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 21st, 2017
Last updated Nov 14th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1972038594 NPPES
Indiana MEDICAID 300005661

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