MEDICARE: DR. GUNDA LEE KIRK D.O.

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	H0523	TX

General Provider Information

NPI Number	:	1831212844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GUNDA LEE KIRK D.O.

Provider Business Mailing Address
First Line	:	2340 E TRINITY MILLS RD STE 250
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-1946
Country	:	US
Telephone Number	:	855-893-5637
Fax Number	:	817-666-3873

Provider Business Practice Location Address
First Line	:	750 EUREKA ST STE B
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-6521
Country	:	US
Telephone Number	:	855-893-5637
Fax Number	:	817-666-3873

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	10/23/2024

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