Provider Demographics
NPI:1871663179
Name:KILKENNY, STEVEN JAMES (MD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JAMES
Last Name:KILKENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1301 HUFFMAN ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-345-2050
Mailing Address - Fax:907-345-9807
Practice Address - Street 1:1301 HUFFMAN ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515
Practice Address - Country:US
Practice Address - Phone:907-345-1199
Practice Address - Fax:907-345-5931
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK1717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD01711Medicaid
AK160380Medicare ID - Type Unspecified
AK160381Medicare ID - Type Unspecified
AKMD01711Medicaid