MEDICARE: DR. JEANNE MARIE KIRKLAND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	45543	OH

General Provider Information

NPI Number	:	1124108980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEANNE MARIE KIRKLAND M.D.

Provider Business Mailing Address
First Line	:	5928 SPRINGBORO PIKE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-3250
Country	:	US
Telephone Number	:	937-433-0220
Fax Number	:	937-433-0623

Provider Business Practice Location Address
First Line	:	5928 SPRINGBORO PIKE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45449-3250
Country	:	US
Telephone Number	:	937-433-0220
Fax Number	:	937-434-4405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	09/28/2010

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