MEDICARE: DR. DAVID CHARLES KIRKWOOD M.D.

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	35-05-0689K	OH

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
2	311178563	OTHER	OH	TAX ID

General Provider Information

NPI Number	:	1932293115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CHARLES KIRKWOOD M.D.

Provider Business Mailing Address
First Line	:	2838 LINDEN AVE
Second Line	:	LOWER LEVEL
City	:	DAYTON
State	:	OH
Zip	:	45410-3049
Country	:	US
Telephone Number	:	937-252-9965
Fax Number	:	937-252-9927

Provider Business Practice Location Address
First Line	:	2838 LINDEN AVE
Second Line	:	LOWER LEVEL
City	:	DAYTON
State	:	OH
Zip	:	45410-3049
Country	:	US
Telephone Number	:	937-252-9965
Fax Number	:	937-252-9927

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	09/23/2010

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