Provider Demographics
NPI:1710108618
Name:KAUK, JUSTIN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:R
Last Name:KAUK
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:PO BOX 603949
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3949
Mailing Address - Country:US
Mailing Address - Phone:919-350-0351
Mailing Address - Fax:919-350-7687
Practice Address - Street 1:3009 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1214
Practice Address - Country:US
Practice Address - Phone:919-232-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC133967207X00000X
NC2016-00165207X00000X, 207XX0801X
NV13999207XX0801X
TXQ2000207XX0801X
IL036130778207XX0801X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130778Medicaid
NC1710108618Medicaid
TXPENDINGMedicaid
OK200557440Medicaid
OK200557440Medicaid
IL036130778Medicaid
TX365667YQ9ZMedicare PIN