Healthcare Provider Details

I. General information

NPI: 1215516265
Provider Name (Legal Business Name): SUZANNE KIRK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 S EDGERTON RD STE B
BRECKSVILLE OH
44141-4206
US

IV. Provider business mailing address

1335 WILLIAM ST
RIVER FOREST IL
60305-1148
US

V. Phone/Fax

Practice location:
  • Phone: 440-526-1974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1215516265
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125.077829
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.153104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: