Healthcare Provider Details

I. General information

NPI: 1558476648
Provider Name (Legal Business Name): JOHN JOSEPH KIRKOWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 SULLIVAN ST
CANTON PA
17724-1733
US

IV. Provider business mailing address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

V. Phone/Fax

Practice location:
  • Phone: 570-673-3197
  • Fax: 570-673-8297
Mailing address:
  • Phone: 570-888-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS003118L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: