Kimberly Kay Wallman, DO

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

5101014957 Issued in MI

Practice address

1414 W Fair Ave Ste 285
Marquette, MI 49855-5406

Phone

(906) 226-4618

NPI assigned

Nov 28, 2005

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

Other identifiers 2

Other names 1

• Kimberly Poglese Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Medical Ambulatory Services for Health PC

  • General Practice Physician
  • Okemos, MI
  • NPI 1821197922
  NPD (past)

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

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544400000000",
    "number": "1720061385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "325 E H ST",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498014760",
            "telephone_number": "906-774-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 W FAIR AVE STE 285",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498555406",
            "telephone_number": "906-226-4618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLMAN",
        "first_name": "KIMBERLY",
        "middle_name": "KAY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-28",
        "last_updated": "2018-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5101014957",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4785309",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00260303",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "POGLESE",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Claire Ellein Waligorski
• Madison Walker
• Sharon Joy Walker, RN
• Robert R Wall, PHARM. D.
• John R Wallace, MD
• Samantha Gean Walsh
• Marla Wardowski, LPN
• Bradley Q Warlick, M.D.
• Tanya Marie Warren, CADC
• Mark A Washnock, M.D.

• Psychiatry Physician in Marquette, MI
• Providers in Marquette, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2018; 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.