Provider Demographics
NPI:1902906605
Name:CORTEZ, KIM J (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:J
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:129 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4949
Practice Address - Country:US
Practice Address - Phone:803-774-1788
Practice Address - Fax:803-774-9113
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY227311207R00000X
SC36528207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC365287Medicaid
SCSC3047OtherMEDICARE
SCSC3047OtherMEDICARE
NYH86701Medicare UPIN