Basic Information
| Provider Information | |||||||||
| NPI: | 1639380637 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATRICK G. KIRK, M.D., INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4760 E GALBRAITH RD | ||||||||
| Address2: | #109 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452366703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137915200 | ||||||||
| FaxNumber: | 5137915229 | ||||||||
| Practice Location | |||||||||
| Address1: | 4760 E GALBRAITH RD | ||||||||
| Address2: | #109 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452366703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137915200 | ||||||||
| FaxNumber: | 5137915229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOSSE | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRAC MGR | ||||||||
| AuthorizedOfficialTelephone: | 5137915200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 2002001121 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.