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General NPI Number Information
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NPI Number | 1912912734
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Entity Type | Organization
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Legal Business Name | GLK ENTERPRISES, LLC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 104 MOHAWK STREET
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City | BROWNSVILLE
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State | KY
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Zip | 42210
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Country | US
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Telephone | 270-597-2155
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Fax | 270-597-3811
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Provider Business Mailing Address
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Address Line | 104 MOHAWK STREET
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City | BROWNSVILLE
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State | KY
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Zip | 42210
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Country | US
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Telephone | 270-597-2155
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Fax | 270-597-3811
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | DR. SANJAY KAUL
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Credential | MD
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Telephone | 270-597-2155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 36833
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License Number State | KY
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