Healthcare Provider Details

I. General information

NPI: 1366892986
Provider Name (Legal Business Name): MICHAEL KIRKOVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 05/27/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 N BUSINESS ROUTE 5
CAMDENTON MO
65020-6872
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 573-346-4446
  • Fax:
Mailing address:
  • Phone: 877-406-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number94-09064
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021037529
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: