Provider Demographics
NPI:1649263716
Name:PILGREEN, KENNETH LEE (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:LEE
Last Name:PILGREEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1490 RABBITTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-7847
Mailing Address - Country:US
Mailing Address - Phone:256-435-4474
Mailing Address - Fax:256-435-4474
Practice Address - Street 1:1490 RABBITTOWN RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272-7847
Practice Address - Country:US
Practice Address - Phone:256-435-4474
Practice Address - Fax:256-435-4474
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL000122742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529901870Medicaid
AL529901870Medicaid
AL000005261Medicare ID - Type Unspecified