Healthcare Provider Details

I. General information

NPI: 1780797803
Provider Name (Legal Business Name): BRIAN G KAUTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/07/2023
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 SPRINGS RD NE
HICKORY NC
28601-3067
US

IV. Provider business mailing address

146 ASHFORD HOLLOW LN
MOORESVILLE NC
28117-9695
US

V. Phone/Fax

Practice location:
  • Phone: 828-256-2112
  • Fax: 828-256-2393
Mailing address:
  • Phone: 828-256-2112
  • Fax: 828-256-2393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200501082
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: