Healthcare Provider Details

I. General information

NPI: 1386196350
Provider Name (Legal Business Name): GLK ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MOHAWK ST
BROWNSVILLE KY
42210-9006
US

IV. Provider business mailing address

104 MOHAWK ST
BROWNSVILLE KY
42210-9006
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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SANJAY KAUL
Title or Position: OWNER/ PHYSICIAN
Credential: MD
Phone: 27059732155