MEDICARE: KIRKWOOD FAMILY PRACTICE, LLC

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	35050689K	OH

General Provider Information

NPI Number	:	1316383276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRKWOOD FAMILY PRACTICE, LLC

Provider Business Mailing Address
First Line	:	2838 LINDEN AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-3049
Country	:	US
Telephone Number	:	937-252-9965
Fax Number	:	937-252-9927

Provider Business Practice Location Address
First Line	:	2838 LINDEN AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-3049
Country	:	US
Telephone Number	:	937-252-9965
Fax Number	:	937-252-9927

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID C KIRKWOOD
Credential	:	M.D.
Telephone Number	:	937-252-9965

Provider Enumeration Date	:	05/20/2013
Last Update Date	:	05/20/2013

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