Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 151 | SD |
NPI | 1508831389 |
---|---|
Provider Name | Dr. Kimberly Sue Montileaux |
First Address | Kyle, SD 57752-0540 |
Second Address | Kyle, SD 57752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 22/05/2012 |