MEDICARE: DR. ADAM LEE KILKENNEY D.O.

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	5101017619	MI
2	207Q00000X	Family Medicine Physician	5101017619	MI
3	207Q00000X	Family Medicine Physician	DR.0060986	CO

General Provider Information

NPI Number	:	1467613158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM LEE KILKENNEY D.O.

Provider Business Mailing Address
First Line	:	5900 BYRON CENTER AVE SW
Second Line	:	ATTN MEDICAL ADMINISTRATION
City	:	WYOMING
State	:	MI
Zip	:	49519-9606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 N ACADEMY BLVD STE 1800
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3658
Country	:	US
Telephone Number	:	719-599-0444
Fax Number	:	719-599-8809

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

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	05/02/2019

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