Provider Demographics
NPI:1093862591
Name:KIRCHER, JOHN R (PA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:KIRCHER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4175 N EUCLID AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2483
Mailing Address - Country:US
Mailing Address - Phone:989-667-0491
Mailing Address - Fax:989-667-0493
Practice Address - Street 1:4175 N EUCLID AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2483
Practice Address - Country:US
Practice Address - Phone:989-667-0491
Practice Address - Fax:989-667-0493
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601001075363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0Z96017OtherMEDICARE GROUP PTAN
MIZ96017094OtherMEDICARE INDIVIDUAL PTAN
MIP43930007OtherINDIVIDUAL PTAN
MIJK001075OtherBLUE CROSS BLUE SHIELD LICENSE
MA010Z960170OtherBLUE CROSS BLUE SHIELD PIN
MI0P43930OtherGROUP PTAN