MEDICARE: GLK ENTERPRISES, LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1386196350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLK ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	104 MOHAWK ST
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9006
Country	:	US
Telephone Number	:	270-597-2155
Fax Number	:	270-597-3811

Provider Business Practice Location Address
First Line	:	104 MOHAWK ST
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9006
Country	:	US
Telephone Number	:	270-597-2155
Fax Number	:	270-597-3811

Authorized Official
Title or Position	:	OWNER/ PHYSICIAN
Name	:	SANJAY KAUL
Credential	:	MD
Telephone Number	:	27059732155

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	10/26/2016

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Directions to “GLK ENTERPRISES, LLC ” Practice Location

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