Basic Information
| Provider Information | |||||||||
| NPI: | 1518960228 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRK | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | GERARD | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4460 RED BANK EXPRESSWAY | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452272173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137915200 | ||||||||
| FaxNumber: | 5137915200 | ||||||||
| Practice Location | |||||||||
| Address1: | 4460 RED BANK EXPRESSWAY | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452272173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137915200 | ||||||||
| FaxNumber: | 5137915229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35051507 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2764763 | 05 | OH | MEDICAID | KI0691629 | 01 | OH | MEDICARE | OTHER | 64931496 | 05 | KY | MEDICAID |