Provider Demographics
NPI:1922176361
Name:KILEY, MICHAEL GERARD (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GERARD
Last Name:KILEY
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:396 BROADWAY
Mailing Address - Street 2:MID HUDSON PHYSICIANS, PC
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4626
Mailing Address - Country:US
Mailing Address - Phone:845-331-3131
Mailing Address - Fax:845-334-2898
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:MID HUDSON PHYSICIANS, PC
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4626
Practice Address - Country:US
Practice Address - Phone:845-331-3131
Practice Address - Fax:845-334-2898
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2015-07-14
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Provider Licenses
StateLicense IDTaxonomies
NY009692363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03834842Medicaid
NY03834842Medicaid