Healthcare Provider Details

I. General information

NPI: 1679708754
Provider Name (Legal Business Name): STEVE THOMAS KIRK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 BEN FRANKLIN BLVD RALEIGH NEUROLOGY
DURHAM NC
27704-2141
US

IV. Provider business mailing address

1540 SUNDAY DR RALEIGH NEUROLOGY
RALEIGH NC
27607-6010
US

V. Phone/Fax

Practice location:
  • Phone: 919-719-8834
  • Fax: 919-582-0528
Mailing address:
  • Phone: 919-719-8834
  • Fax: 919-582-0528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number2010-01780
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2010-01780
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: