Healthcare Provider Details

I. General information

NPI: 1083678304
Provider Name (Legal Business Name): MICHAEL C KILPATRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 MEDICAL PL
SEYMOUR IN
47274
US

IV. Provider business mailing address

1124 MEDICAL PL
SEYMOUR IN
47274
US

V. Phone/Fax

Practice location:
  • Phone: 812-522-1613
  • Fax: 812-522-1613
Mailing address:
  • Phone: 812-522-1613
  • Fax: 812-522-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01030226
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: