MEDICARE: DR. TODD S 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	207W00000X	Ophthalmology Physician	036068842	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811955560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD S KIRK MD

Provider Business Mailing Address
First Line	:	13303 S RIDGELAND AVE
Second Line	:	SUITE B
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1815
Country	:	US
Telephone Number	:	708-857-7990
Fax Number	:

Provider Business Practice Location Address
First Line	:	13303 S RIDGELAND AVE
Second Line	:	SUITE B
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1815
Country	:	US
Telephone Number	:	708-857-7990
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	08/15/2013

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