MEDICARE: DR. ANDREW KENNETH KILUK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	2006-01801	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2006-01801	OTHER	NC	LICENSE MEDICAL

General Provider Information

NPI Number	:	1285650945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW KENNETH KILUK MD

Provider Business Mailing Address
First Line	:	3701 JOHN PLATT DRIVE
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3280
Country	:	US
Telephone Number	:	252-622-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 JOHN PLATT DRIVE
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-3280
Country	:	US
Telephone Number	:	252-622-4448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	03/07/2023

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