Provider Demographics
NPI:1265444855
Name:SIRMONS, KEVIN (MD, NRP, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:SIRMONS
Suffix:
Gender:M
Credentials:MD, NRP, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-9641
Mailing Address - Country:US
Mailing Address - Phone:672-370-5296
Mailing Address - Fax:215-230-3725
Practice Address - Street 1:75 E STREET RD
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6047
Practice Address - Country:US
Practice Address - Phone:267-684-1047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47780207P00000X, 207Q00000X
PAMD440260207P00000X, 207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN340425100Medicaid
MN567K8SIOtherBLUE CROSS BLUE SHIELD MN
MNHP54848OtherHEALTH PARTNERS
MN2371998OtherAMERICA'S PPO
MNI34911Medicare UPIN
MN080014288Medicare ID - Type Unspecified