Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2014-02169 | NC |
N | 111NI0900X | Internist | 2014-02169 | NC |
N | 207RC0200X | Critical Care Medicine | 2014-02169 | NC |
Y | 207RP1001X | Pulmonary Disease | 01081868A | IN |
N | 207RP1001X | Pulmonary Disease | 2014-02169 | NC |
NPI | 1053576496 |
---|---|
Provider Name | Dr. Samuel Wamathai Kimani |
First Address | Bloomington, IN 47403-3239 |
Second Address | Bloomington, IN 47403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2008 |
Last Update Date | 19/03/2021 |