Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | SC004716-L | PA |
N | 222Z00000X | Podiatrist | SC004716-L | PA |
N | 111NR0200X | Radiology | SC004716-L | PA |
N | 213ER0200X | Radiology | SC004716-L | PA |
Y | 213ES0131X | Foot Surgery | SC004716-L | PA |
NPI | 1801812292 |
---|---|
Provider Name | Kenneth W. Kilgore |
First Address | Lititz, PA 17543-9482 |
Second Address | Lititz, PA 17543-9482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 17/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0477086001 | PIN FOR CIGNA (01) | PA |
13162415 | PIN FOR WASAU (01) | PA |
1410834 | PIN FOR HIGHMARK (01) | PA |
2102717 | PIN FOR MAMSI (01) | PA |
2280961 | IMPIN FOR UNITEDHEALTHCAR (01) | PA |
50007507 | PIN FOR CAP BLUE CROSS (01) | PA |
U89333 | (02) | PA |