Provider Demographics
NPI:1528075199
Name:PLOEHN, KIMBERLY L (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:PLOEHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8558 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-392-7084
Mailing Address - Fax:219-703-6854
Practice Address - Street 1:10215 BROADWAY FL 1
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8001
Practice Address - Country:US
Practice Address - Phone:219-661-6098
Practice Address - Fax:219-703-6812
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01094884A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300096697Medicaid
MI3084194Medicaid
IN1104457857OtherANTHEM