Healthcare Provider Details

I. General information

NPI: 1912912734
Provider Name (Legal Business Name): GLK ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MOHAWK STREET
BROWNSVILLE KY
42210
US

IV. Provider business mailing address

104 MOHAWK STREET
BROWNSVILLE KY
42210
US

V. Phone/Fax

Practice location:
  • Phone: 270-597-2155
  • Fax: 270-597-3811
Mailing address:
  • Phone: 270-597-2155
  • Fax: 270-597-3811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number36833
License Number StateKY

VIII. Authorized Official

Name: DR. SANJAY KAUL
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 270-597-2155