MEDICARE: DR. MARK BAIRD KIRKLAND DO

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	02041	IA

General Provider Information

NPI Number	:	1881714079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK BAIRD KIRKLAND DO

Provider Business Mailing Address
First Line	:	3408 WOODLAND AVE
Second Line	:	STE 205
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6506
Country	:	US
Telephone Number	:	515-226-1222
Fax Number	:	515-226-1200

Provider Business Practice Location Address
First Line	:	3408 WOODLAND AVE
Second Line	:	STE 205
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-6506
Country	:	US
Telephone Number	:	515-226-1222
Fax Number	:	515-226-1200

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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