Healthcare Provider Details

I. General information

NPI: 1013965805
Provider Name (Legal Business Name): HOLLY FRITCH KIRBY, M.D., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 NALL AVE SUITE 100
LEAWOOD KS
66211-1669
US

IV. Provider business mailing address

11201 NALL AVE SUITE 100
LEAWOOD KS
66211-1669
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-3030
  • Fax:
Mailing address:
  • Phone: 913-451-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number18382
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number18382
License Number StateKS

VIII. Authorized Official

Name: DR. HOLLY FRITCH
Title or Position: MANAGER
Credential: M.D.
Phone: 913-451-3030