Healthcare Provider Details

I. General information

NPI: 1043471444
Provider Name (Legal Business Name): MARGARET JACKSON KIHLSTROM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR ROOM 1107G WEST WING
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

101 MANNING DR ROOM 1107G WEST WING
CHAPEL HILL NC
27514-4220
US

V. Phone/Fax

Practice location:
  • Phone: 919-843-0014
  • Fax: 919-966-0290
Mailing address:
  • Phone: 919-843-0014
  • Fax: 919-966-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number148767
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number2011-00076
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: