Provider Demographics
NPI:1003230095
Name:KILGORE, DARREN
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:
Last Name:KILGORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 WALKER ST
Mailing Address - Street 2:538
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-4258
Mailing Address - Country:US
Mailing Address - Phone:313-610-0134
Mailing Address - Fax:
Practice Address - Street 1:269 WALKER ST
Practice Address - Street 2:538
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-4258
Practice Address - Country:US
Practice Address - Phone:313-610-0134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374U00000XNursing Service Related ProvidersHome Health Aide