Provider Demographics
NPI:1164563565
Name:KILBY, MICHAEL WARREN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WARREN
Last Name:KILBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-1209
Mailing Address - Country:US
Mailing Address - Phone:336-751-8307
Mailing Address - Fax:336-751-8402
Practice Address - Street 1:223 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2038
Practice Address - Country:US
Practice Address - Phone:336-751-8307
Practice Address - Fax:336-751-8402
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801335207P00000X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891180QMedicaid
NC891180QMedicaid
NC2279828BMedicare ID - Type UnspecifiedMEDICARE EKG
NCG08459Medicare UPIN