MEDICARE: KERRI J KIRCHHOFF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	18950	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00144981	OTHER	OK	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720081623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRI J KIRCHHOFF MD

Provider Business Mailing Address
First Line	:	3433 NW 56TH ST, SUITE C-40
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4455
Country	:	US
Telephone Number	:	405-945-4741
Fax Number	:	888-972-5320

Provider Business Practice Location Address
First Line	:	3433 NW 56TH ST, SUITE C-40
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-4455
Country	:	US
Telephone Number	:	405-945-4741
Fax Number	:	888-972-5320

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/14/2021

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