Provider Demographics
NPI:1003895665
Name:KIRK, EARL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:DAVID
Last Name:KIRK
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 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:316-260-1690
Mailing Address - Fax:316-260-1691
Practice Address - Street 1:2600 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2729
Practice Address - Country:US
Practice Address - Phone:316-260-1690
Practice Address - Fax:316-260-1691
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-12929207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100080970EMedicaid
KS100080970CMedicaid
KSP01335049Medicare PIN
KS104105Medicare PIN
KS100080970CMedicaid
KS100080970EMedicaid