Provider Demographics
NPI:1558342550
Name:ENCARNACION KUILAN, EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:ENCARNACION KUILAN
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:PMB 22 PO BOX 607071
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-7071
Mailing Address - Country:US
Mailing Address - Phone:787-391-8187
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON SHOPPING CENTER
Practice Address - Street 2:OFFICE 3
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960-7071
Practice Address - Country:US
Practice Address - Phone:787-391-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10337208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F45784Medicare UPIN