Healthcare Provider Details

I. General information

NPI: 1003041849
Provider Name (Legal Business Name): KIRK PHILLIP HEITMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2009
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST MS117
LEXINGTON KY
40536-0298
US

IV. Provider business mailing address

800 ROSE ST MS117
LEXINGTON KY
40536-0298
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-1446
  • Fax:
Mailing address:
  • Phone: 859-257-1446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number25MA09992400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number47049
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number47049
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25MA09992400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: