Provider Demographics
NPI:1174566657
Name:KIRK, MICHAEL B (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:KIRK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:444 E HUNTINGTON DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-6203
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6036
Practice Address - Street 1:444 E HUNTINGTON DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-6203
Practice Address - Country:US
Practice Address - Phone:626-447-0296
Practice Address - Fax:626-447-6036
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-07-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG58073207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E84201Medicare UPIN
WG58073BMedicare PIN