Provider Demographics
NPI:1790947109
Name:CLOTHIER, KILBURN (MD)
Entity Type:Individual
Prefix:DR
First Name:KILBURN
Middle Name:
Last Name:CLOTHIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:W.J.KILBURN
Other - Middle Name:
Other - Last Name:CLOTHIER
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:316 E GAUER CIR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-2622
Mailing Address - Country:US
Mailing Address - Phone:414-617-1008
Mailing Address - Fax:
Practice Address - Street 1:316 E GAUER CIR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-2622
Practice Address - Country:US
Practice Address - Phone:414-617-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15174-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB52123Medicare UPIN