Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 19552 | KY |
N | 208600000X | Surgeon | 19552 | KY |
N | 2082S0105X | Plastic Hand Surgeon | 19552 | KY |
NPI | 1679681076 |
---|---|
Provider Name | Joel G Kreilein |
First Address | Southgate, KY 41071 |
Second Address | Southgate, KY 41071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000033112 | ANTHEM BLUE CROSS & SHIEL (01) | |
1320080 | UNITED HEALTHCARE (01) | |
64195522 | (05) | KY |
C02039 | (02) |