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General NPI Number Information
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NPI Number | 1316383276
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Entity Type | Organization
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Legal Business Name | KIRKWOOD FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 2838 LINDEN AVE
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City | DAYTON
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State | OH
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Zip | 45410-3049
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Country | US
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Telephone | 937-252-9965
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Fax | 937-252-9927
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Provider Business Mailing Address
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Address Line | 2838 LINDEN AVE
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City | DAYTON
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State | OH
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Zip | 45410-3049
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Country | US
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Telephone | 937-252-9965
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Fax | 937-252-9927
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID C KIRKWOOD
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Credential | M.D.
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Telephone | 937-252-9965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35050689K
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License Number State | OH
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