Provider Demographics
NPI:1902179898
Name:2D RECON BN
Entity Type:Organization
Organization Name:2D RECON BN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BATTALION SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KAMINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-440-7712
Mailing Address - Street 1:2D MARINE DIVISION, 2D RECON BN
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0138
Mailing Address - Country:US
Mailing Address - Phone:910-440-7401
Mailing Address - Fax:
Practice Address - Street 1:2D MARINE DIVISION, 2D RECON BN
Practice Address - Street 2:PSC BOX 20138
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0138
Practice Address - Country:US
Practice Address - Phone:910-440-7401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Multi-Specialty