Healthcare Provider Details

I. General information

NPI: 1629462569
Provider Name (Legal Business Name): KEVIN KILGALLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13121 E 17TH AVE
AURORA CO
80045-2535
US

IV. Provider business mailing address

13121 E 17TH AVE
AURORA CO
80045-2535
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-2393
  • Fax:
Mailing address:
  • Phone: 303-724-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0145808
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberDR.0060161
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: