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1962487611

NPI Code Detail

MEDICARE: KIRK EDWARD WINWARD MD

MEDICARE: KIRK EDWARD WINWARD 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	187019 1205	UT
2	207W00000X	Ophthalmology Physician	187019-1205	UT
3	207WX0107X	Retina Specialist (Ophthalmology) Physician	187019-1205	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	005545102	OTHER		MEDICARE
2	180013350	OTHER		RAILROAD MEDICARE
5	005584702	OTHER		MEDICARE
7	000010486	OTHER		MEDICARE
8	005545202	OTHER		MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	870525682	OTHER		TAX ID #
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962487611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK EDWARD WINWARD MD

Provider Business Mailing Address
First Line	:	5169 COTTONWOOD ST STE 630
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6771
Country	:	US
Telephone Number	:	801-281-3030
Fax Number	:	801-281-3033

Provider Business Practice Location Address
First Line	:	5169 COTTONWOOD ST STE 630
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6771
Country	:	US
Telephone Number	:	801-281-3030
Fax Number	:	801-281-3033

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	02/05/2018

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Directions to “ KIRK EDWARD WINWARD MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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