Provider Demographics
NPI:1801812292
Name:KILGORE, KENNETH W (DPM)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:KILGORE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 COPPERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-9482
Mailing Address - Country:US
Mailing Address - Phone:717-626-7666
Mailing Address - Fax:717-626-1605
Practice Address - Street 1:46 COPPERFIELD CIR
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9482
Practice Address - Country:US
Practice Address - Phone:717-626-7666
Practice Address - Fax:717-626-1605
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004716-L213E00000X, 213ER0200X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
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