Provider Demographics
NPI:1285813923
Name:SUSAN H KIRKPATRICK DPM INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SUSAN H KIRKPATRICK DPM INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:HEIDI
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:626-574-7592
Mailing Address - Street 1:PO BOX 1695
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91077-1695
Mailing Address - Country:US
Mailing Address - Phone:626-574-7592
Mailing Address - Fax:626-447-3704
Practice Address - Street 1:20 E HUNTINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91077-1695
Practice Address - Country:US
Practice Address - Phone:626-574-7592
Practice Address - Fax:626-447-3704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3748213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty