Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101017619 | MI |
N | 207Q00000X | Family Doctor | 5101017619 | MI |
Y | 207Q00000X | Family Doctor | DR.0060986 | CO |
NPI | 1467613158 |
---|---|
Provider Name | Dr. Adam Lee Kilkenney |
First Address | Wyoming, MI 49519-9606 |
Second Address | Colorado Springs, CO 80918-3658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 02/05/2019 |