Provider Demographics
NPI:1861761934
Name:KB MEDICAL, INC.
Entity type:Organization
Organization Name:KB MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KOLISEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-297-1198
Mailing Address - Street 1:8455
Mailing Address - Street 2:CASTLEWOOD DRIVE, SUITE J
Mailing Address - City:IDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:317-727-2791
Mailing Address - Fax:317-859-0912
Practice Address - Street 1:8455
Practice Address - Street 2:CASTLEWOOD DRIVE, SUITE J
Practice Address - City:IDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-727-2791
Practice Address - Fax:317-859-0912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies