MEDICARE: DR. ANTHONY W KIRILUK MD

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	207Q00000X	Family Medicine Physician	21153	WA

General Provider Information

NPI Number	:	1356480719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY W KIRILUK MD

Provider Business Mailing Address
First Line	:	18222 TERRACE CT SW
Second Line	:
City	:	NORMANDY PARK
State	:	WA
Zip	:	98166-3860
Country	:	US
Telephone Number	:	206-241-9798
Fax Number	:

Provider Business Practice Location Address
First Line	:	18222 TERRACE CT SW
Second Line	:
City	:	NORMANDY PARK
State	:	WA
Zip	:	98166-3860
Country	:	US
Telephone Number	:	206-241-9798
Fax Number	:

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

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	07/08/2007

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