Healthcare Provider Details

I. General information

NPI: 1386620730
Provider Name (Legal Business Name): KIRK J. WOJNO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 N STEPHENSON HWY STE 300
ROYAL OAK MI
48067-1508
US

IV. Provider business mailing address

5100 TALLEY RD STE 300
LITTLE ROCK AR
72204-8040
US

V. Phone/Fax

Practice location:
  • Phone: 601-500-6767
  • Fax: 248-336-3395
Mailing address:
  • Phone: 501-500-6640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0104X
TaxonomyChemical Pathology Physician
License Number4301062774
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number4301062774
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: