MEDICARE: DR. MICHAEL GENE KIDD 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	174400000X	Specialist	33076	NC
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	33076	NC
3	207L00000X	Anesthesiology Physician	33076	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	48929	OTHER	NC	BCBS/STATE

General Provider Information

NPI Number	:	1720087836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL GENE KIDD M.D.

Provider Business Mailing Address
First Line	:	11722 NC 41 HWY W
Second Line	:
City	:	BLADENBORO
State	:	NC
Zip	:	28320-7826
Country	:	US
Telephone Number	:	910-374-9721
Fax Number	:

Provider Business Practice Location Address
First Line	:	LANSTUHL REGIONAL MEDICAL CENTER
Second Line	:	UNIT 33100
City	:	APO
State	:	AE
Zip	:	09180
Country	:	US
Telephone Number	:	910-374-9721
Fax Number	:

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/20/2023

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