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General NPI Number Information
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NPI Number | 1902211212
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Entity Type | Organization
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Legal Business Name | DR. MICHAEL R. KILGORE, MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 06/25/2014
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Last Update Date | 06/25/2014
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Provider Practice Location Address
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Address Line | 5265 N 23RD ST SUITE A
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City | MCALLEN
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State | TX
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Zip | 78504-4004
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Country | US
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Telephone | 956-687-6196
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Fax | 956-687-9169
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Provider Business Mailing Address
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Address Line | 5265 N 23RD ST SUITE A
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City | MCALLEN
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State | TX
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Zip | 78504-4004
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Country | US
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Telephone | 956-687-6196
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Fax | 956-687-9169
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Authorized Official
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Title or Position | SOLE/PROPRIETOR
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Name | DR. MICHAEL RAY KILGORE
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Credential | M.D.
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Telephone | 956-687-6196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H1123
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License Number State | TX
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