Provider Demographics
NPI:1790745917
Name:KUIKEN, GARRY HENRY (MD)
Entity Type:Individual
Prefix:
First Name:GARRY
Middle Name:HENRY
Last Name:KUIKEN
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 1:249 FRANKLIN PIKE SE
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-2893
Mailing Address - Country:US
Mailing Address - Phone:540-745-5700
Mailing Address - Fax:540-745-5703
Practice Address - Street 1:249 FRANKLIN PIKE SE
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-2893
Practice Address - Country:US
Practice Address - Phone:540-745-5700
Practice Address - Fax:540-745-5703
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005622247Medicaid
VA005622247Medicaid
VA080007748Medicare ID - Type UnspecifiedPROVIDER ID