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General NPI Number Information
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NPI Number | 1639380637
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Entity Type | Organization
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Legal Business Name | PATRICK G. KIRK, M.D., INC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4760 E GALBRAITH RD #109
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City | CINCINNATI
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State | OH
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Zip | 45236-6703
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Country | US
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Telephone | 513-791-5200
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Fax | 513-791-5229
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Provider Business Mailing Address
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Address Line | 4760 E GALBRAITH RD #109
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City | CINCINNATI
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State | OH
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Zip | 45236-6703
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Country | US
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Telephone | 513-791-5200
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Fax | 513-791-5229
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Authorized Official
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Title or Position | PRAC MGR
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Name | JANE BOSSE
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Credential |
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Telephone | 513-791-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2002001121
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License Number State | OH
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