Provider Demographics
NPI:1205180049
Name:KILGORE, PAUL EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EVAN
Last Name:KILGORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:259 MACK AVE
Mailing Address - Street 2:SUITE 2118
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2427
Mailing Address - Country:US
Mailing Address - Phone:313-577-1215
Mailing Address - Fax:313-577-5369
Practice Address - Street 1:259 MACK AVE
Practice Address - Street 2:SUITE 2118
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2427
Practice Address - Country:US
Practice Address - Phone:313-577-1215
Practice Address - Fax:313-577-5369
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301058415207R00000X
MI53155048724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine