Healthcare Provider Details

I. General information

NPI: 1053338889
Provider Name (Legal Business Name): JANUSZ K KIKUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE DEPT. OF RADIOLOGY
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

162 LAKEWOOD PKWY
BURLINGTON VT
05401-2763
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3592
  • Fax: 802-847-4822
Mailing address:
  • Phone: 802-847-3592
  • Fax: 802-847-4822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number0420010069
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: