Healthcare Provider Details

I. General information

NPI: 1619954021
Provider Name (Legal Business Name): DAVID DALE KIRKPATRICK III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7502 STATE RD STE. 1180
CINCINNATI OH
45255-2800
US

IV. Provider business mailing address

1270 SOLUTIONS CENTER P.O. BOX 771270
CHICAGO IL
60677-1002
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-8181
  • Fax: 513-624-2956
Mailing address:
  • Phone: 513-542-6898
  • Fax: 513-542-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35053895
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35053895
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: