MEDICARE: DR. JEAN H KIRK MD

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	2085R0204X	Vascular & Interventional Radiology Physician	MD041645L	PA

General Provider Information

NPI Number	:	1447249537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN H KIRK MD

Provider Business Mailing Address
First Line	:	BROAD AND VINE STREETS
Second Line	:	MS310
City	:	PHILA
State	:	PA
Zip	:	19102
Country	:	US
Telephone Number	:	215-762-1808
Fax Number	:	215-762-1255

Provider Business Practice Location Address
First Line	:	BROAD AND VINE STREETS
Second Line	:	MS310
City	:	PHILA
State	:	PA
Zip	:	19102
Country	:	US
Telephone Number	:	215-762-1808
Fax Number	:	215-762-1255

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	09/03/2014

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