Individual
DR. KENNETH HILSBOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5 ERWIN LN STE B, FAIRMONT, WV 26554-1376
(304) 612-9186
(304) 366-7763
Mailing address
5 ERWIN LN STE B, FAIRMONT, WV 26554-1376
(304) 612-9186
(304) 366-7763
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17553
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810003579
—
WV
Enumeration date
07/12/2006
Last updated
06/21/2021
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