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NPI Code Detail

MEDICARE: MR. ROBERT BIRK JR. PA-C

MEDICARE: MR. ROBERT BIRK JR. PA-C
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
1363A00000XPhysician Assistant1515WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2390848401050OTHERWIBCBX
31515OTHERWISTATE LICENSE
41851477913OTHERCMH NPI

General Provider Information

NPI Number : 1215024716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROBERT BIRK JR. PA-C
Provider Business Mailing Address
First Line : 240 MAPLE ST
Second Line :
City : WOODRUFF
State : WI
Zip : 54568-9190
Country : US
Telephone Number : 715-356-8000
Fax Number :
Provider Business Practice Location Address
First Line : 240 MAPLE ST
Second Line :
City : WOODRUFF
State : WI
Zip : 54568-9190
Country : US
Telephone Number : 715-356-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 11/12/2019

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