Provider Demographics
NPI:1861434508
Name:LORD-STRULOVIC, KIMBERLY BETH (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:BETH
Last Name:LORD-STRULOVIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:BETH
Other - Last Name:LORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5252 LAGORCE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2106
Mailing Address - Country:US
Mailing Address - Phone:305-865-1656
Mailing Address - Fax:
Practice Address - Street 1:3625 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4207
Practice Address - Country:US
Practice Address - Phone:904-702-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU8088208000000X
FLME91439208000000X
OH35.132081208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272092200Medicaid