Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD060588L | PA |
Y | 208600000X | Surgeon | MD060588L | PA |
N | 2086S0102X | Surgical Critical Care | MD060588L | PA |
N | 2086S0127X | Trauma Surgeon | MD060588L | PA |
NPI | 1245250943 |
---|---|
Provider Name | Dr. Kris R. Kaulback |
First Address | Philadelphia, PA 19106-4404 |
Second Address | Philadelphia, PA 19107-5563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 31/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001793933 | (05) | PA |
8168903 | (05) | NJ |