Kimberly A Dettloff, M.D.

Primary specialty

Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X

License

036-086013 Issued in IL

Practice address

1830 Jarvis Ave
Elk Grove Village, IL 60007-2440

Phone

(615) 778-4066

NPI assigned

Mar 23, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• American Current Care, P.a.

  • Health Service Clinic/Center
  • Addison, TX
  • NPI 1730360124
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266451200000",
    "number": "1114044476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5080 SPECTRUM DR",
            "address_2": "SUITE 1200W",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750014648",
            "telephone_number": "972-364-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 JARVIS AVE",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600072440",
            "telephone_number": "615-778-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTLOFF",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-23",
        "last_updated": "2010-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "IL",
            "license": "036-086013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lailanie Dela Cruz, RBT
• Mary Ann Deliberto, R.N., A.P.N.
• Kimberly Sue Dennis, CNM, WHNP-BC
• Dentistry for All Ages Inc.
• Dalton Depoy
• Dia Aesthetics LLC
• Dialyze Direct Il LLC
• Edward J Diamond, M.D.
• Anthony D Diaz, DO
• Emily Marie Diaz, CRNA

• Preventive Medicine/Occupational Environmental Medicine Physician in Elk Grove Village, IL
• Providers in Elk Grove Village, IL by specialty
• Preventive Medicine/Occupational Environmental Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.