Provider Demographics
NPI:1164633467
Name:KIRKLAND, CLEM RYAN (MD)
Entity Type:Individual
Prefix:
First Name:CLEM
Middle Name:RYAN
Last Name:KIRKLAND
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 1:3555 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3912
Mailing Address - Country:US
Mailing Address - Phone:614-268-2748
Mailing Address - Fax:614-263-3376
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 4000
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-268-2748
Practice Address - Fax:614-263-3376
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCFK1416812207N00000X
OH35122088207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9635948OtherAETNA
OH3526464OtherUNITED HEALTH CARE
OH000000824343OtherANTHEM BC/BS
OH000000824343OtherANTHEM BC/BS