Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 96000154 | NC |
NPI | 1346238862 |
---|---|
Provider Name | Dr. Michael Clark Kinnebrew |
First Address | Wilmington, NC 28401-7305 |
Second Address | Wilmington, NC 28401-7305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 01/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10272203 | VOCATIONAL REHABILITATION (01) | NC |
49309 | BLUE CROSS BLUE SHIELD (01) | NC |
8949309 | (05) | NC |
8994921 | (05) | NC |
979443 | UNITED CONCORDIA (01) | |
B89884 | (02) | NC |