Provider Demographics
NPI:1285650945
Name:KILUK, ANDREW KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:KENNETH
Last Name:KILUK
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 1:3701 JOHN PLATT DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-3280
Mailing Address - Country:US
Mailing Address - Phone:252-622-4448
Mailing Address - Fax:
Practice Address - Street 1:3701 JOHN PLATT DRIVE
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-3280
Practice Address - Country:US
Practice Address - Phone:252-622-4448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-018012080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378279400Medicaid
NC2006-01801OtherLICENSE MEDICAL
NC2006-01801OtherLICENSE MEDICAL
FLBK4362858OtherDEA #
NC2006-01801OtherLICENSE MEDICAL