Provider Demographics
NPI:1346322625
Name:KILGUS, ANDREW H (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:KILGUS
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:1600 W NORTHWEST HWY
Practice Address - Street 2:STE 900
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8112
Practice Address - Country:US
Practice Address - Phone:817-488-7573
Practice Address - Fax:817-488-5096
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG4326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140442888Medicaid
TX2131717OtherCIGNA PIN
TX4019422OtherAETNA PIN
TX73652OtherFIRSTHEALTH PIN
TX138216OtherPHCS PIN
TX140442891Medicaid
TX00U87ZOtherBCBSTX GRP PIN
1750369203OtherGRP NPI NUMBER
TXKILAB23950OtherCCHIP PIN
TX116765100OtherFIRSTCARE PIN
TX151816901Medicaid
TX303413OtherUHC PIN
TX87Y240OtherBCBSTX IND PIN
TX00479RMedicare PIN
TX140442891Medicaid
TXKILAB23950OtherCCHIP PIN