Provider Demographics
NPI:1205832383
Name:KVILEKVAL, KARA (MD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:
Last Name:KVILEKVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-4068
Mailing Address - Country:US
Mailing Address - Phone:631-246-8289
Mailing Address - Fax:631-246-8294
Practice Address - Street 1:4 TECHNOLOGY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4068
Practice Address - Country:US
Practice Address - Phone:631-246-8289
Practice Address - Fax:631-246-8294
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2010-06-25
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NY162761-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50F111Medicare PIN
NYE62713Medicare UPIN