MEDICARE: CLEM KIRKLAND, M.D., INC

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

General Provider Information

NPI Number	:	1740461763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEM KIRKLAND, M.D., INC

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	:

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	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CLEM KIRKLAND
Credential	:	M.D.
Telephone Number	:	937-433-0220

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	09/26/2010

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