Provider Demographics
NPI:1902971690
Name:KILGORE, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:KILGORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5265 N 23RD ST STE A
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4004
Mailing Address - Country:US
Mailing Address - Phone:956-687-6196
Mailing Address - Fax:956-687-7662
Practice Address - Street 1:5265 N 23RD ST STE A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4004
Practice Address - Country:US
Practice Address - Phone:956-687-6196
Practice Address - Fax:956-687-7662
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXMD H 1123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QV22Medicare PIN