MEDICARE: DR. PAUL EVAN KILGORE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301058415	MI
2	207R00000X	Internal Medicine Physician	53155048724	MI

General Provider Information

NPI Number	:	1205180049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL EVAN KILGORE M.D.

Provider Business Mailing Address
First Line	:	259 MACK AVE
Second Line	:	SUITE 2118
City	:	DETROIT
State	:	MI
Zip	:	48201-2427
Country	:	US
Telephone Number	:	313-577-1215
Fax Number	:	313-577-5369

Provider Business Practice Location Address
First Line	:	259 MACK AVE
Second Line	:	SUITE 2118
City	:	DETROIT
State	:	MI
Zip	:	48201-2427
Country	:	US
Telephone Number	:	313-577-1215
Fax Number	:	313-577-5369

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2012
Last Update Date	:	11/01/2012

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