Individual
DR. KRIS R. KAULBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1100 WALNUT ST, PHILADELPHIA, PA 19107-5563
(215) 955-6750
(215) 923-8222
Mailing address
615 CHESTNUT ST, 14TH FLOOR, PHILADELPHIA, PA 19106-4404
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD060588L
PA
2086S0102X
Surgical Critical Care Physician
MD060588L
PA
2086S0127X
Trauma Surgery Physician
MD060588L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001793933
—
PA
05
—
8168903
—
NJ
Enumeration date
07/19/2006
Last updated
05/31/2011
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