Provider Demographics
NPI:1942463401
Name:KIM, PATRICK S (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 OLD SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5951
Mailing Address - Country:US
Mailing Address - Phone:636-579-8544
Mailing Address - Fax:
Practice Address - Street 1:3961 OLD SPARTA RD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5951
Practice Address - Country:US
Practice Address - Phone:636-579-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-05
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-132821207L00000X
MO2013009611207L00000X
OK37638207L00000X
TN67040207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty