MEDICARE: DR. ERIC S KIRKENDALL 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	208000000X	Pediatrics Physician	35.087595	OH

General Provider Information

NPI Number	:	1770527178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC S KIRKENDALL MD

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27102-0344
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-3026
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/18/2018

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