Provider Demographics
NPI:1033352737
Name:KIRCHOFF, JEREMY BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:BRUCE
Last Name:KIRCHOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:
Practice Address - Street 1:12210 W 87TH STREET PKWY
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2812
Practice Address - Country:US
Practice Address - Phone:913-438-6700
Practice Address - Fax:913-338-1311
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001473207Q00000X
KS04-33820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine