Healthcare Provider Details

I. General information

NPI: 1184164238
Provider Name (Legal Business Name): DANIEL KIRKPATRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461
US

IV. Provider business mailing address

48 MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8197
  • Fax:
Mailing address:
  • Phone: 314-226-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMED-PHYS-LIC-118828
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01082702A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: