Provider Demographics
NPI:1245228253
Name:WOOLHISER, KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:WOOLHISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1501
Mailing Address - Country:US
Mailing Address - Phone:605-782-2000
Mailing Address - Fax:605-782-2721
Practice Address - Street 1:1310 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1501
Practice Address - Country:US
Practice Address - Phone:605-782-2000
Practice Address - Fax:605-782-2721
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3893207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0966846Medicaid
SD6002790Medicaid
IA0966846Medicaid
SDS4034Medicare ID - Type Unspecified