Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 2006-01801 | NC |
NPI | 1285650945 |
---|---|
Provider Name | Dr. Andrew Kenneth Kiluk |
First Address | Morehead City, NC 28557-3280 |
Second Address | Morehead City, NC 28557-3280 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 15/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2006-01801 | LICENSE MEDICAL (01) | NC |
378279400 | (05) | FL |
BK4362858 | DEA # (01) | FL |
G05917 | (02) | FL |