Provider Demographics
NPI:1003069071
Name:KIRLEW, KONRAD ANDREW THEODORE (MD)
Entity Type:Individual
Prefix:
First Name:KONRAD
Middle Name:ANDREW THEODORE
Last Name:KIRLEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3887
Mailing Address - Country:US
Mailing Address - Phone:954-237-6413
Mailing Address - Fax:954-636-8218
Practice Address - Street 1:9410 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3887
Practice Address - Country:US
Practice Address - Phone:954-237-6413
Practice Address - Fax:954-636-8218
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME678972085R0202X
MO20080266942085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology