Healthcare Provider Details

I. General information

NPI: 1740660414
Provider Name (Legal Business Name): WILBY KURIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VEAZEY DR
BUTNER NC
27509-1668
US

IV. Provider business mailing address

300 VEAZEY DR
BUTNER NC
27509-1668
US

V. Phone/Fax

Practice location:
  • Phone: 919-322-8207
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019-00872
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101263777
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: