Healthcare Provider Details

I. General information

NPI: 1861552416
Provider Name (Legal Business Name): MARK DAVID KILMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

406 NW 233RD TER
NEWBERRY FL
32669-2290
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0077
  • Fax:
Mailing address:
  • Phone: 201-341-5182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTRN9471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: