Healthcare Provider Details

I. General information

NPI: 1710289236
Provider Name (Legal Business Name): MARC KAJUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2010
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4275 WESTERN BLVD
JACKSONVILLE NC
28546-1100
US

IV. Provider business mailing address

4275 WESTERN BLVD
JACKSONVILLE NC
28546-1100
US

V. Phone/Fax

Practice location:
  • Phone: 910-938-3099
  • Fax: 910-938-3243
Mailing address:
  • Phone: 910-938-3099
  • Fax: 910-938-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2019-00498
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: