Mkilgannonmd LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

025777 Issued in CT

Legal business name

MKILGANNONMD LLC

Practice address

14 Club Rd
Windham, CT 06280-1000

Phone

(860) 456-1107

Fax

(860) 283-9468

NPI assigned

Apr 28, 2016

Last updated

Apr 28, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Kilgannon

Title

Owner

Phone

(860) 283-2839

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461801600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461801600000",
    "number": "1437504388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 FIELDSTONE DR",
            "city": "STORRS",
            "state": "CT",
            "postal_code": "062682572",
            "telephone_number": "860-283-2839",
            "fax_number": "860-283-9468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 CLUB RD",
            "city": "WINDHAM",
            "state": "CT",
            "postal_code": "062801000",
            "telephone_number": "860-456-1107",
            "fax_number": "860-283-9468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MKILGANNONMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-28",
        "last_updated": "2016-04-28",
        "status": "A",
        "authorized_official_last_name": "KILGANNON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-283-2839"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "025777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Hayward
• Arlene Susan Hendricks, RPT
• Devon Hock, PT, DPT
• Jennifer Jones
• Holly Beth Marvel, P.T.
• Joel Lee Reinholtz, PTA
• Saint Josephs Living Center Inc
• Jordyn Staveski
• Krystle Lynn Sullivan, LPC
• Sarah Jean Sylvia, OTR/L

• Internal Medicine Physician in Windham, CT
• Providers in Windham, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.