Provider Demographics
NPI:1316383276
Name:KIRKWOOD FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:KIRKWOOD FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIRKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-252-9965
Mailing Address - Street 1:2838 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-3049
Mailing Address - Country:US
Mailing Address - Phone:937-252-9965
Mailing Address - Fax:937-252-9927
Practice Address - Street 1:2838 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-3049
Practice Address - Country:US
Practice Address - Phone:937-252-9965
Practice Address - Fax:937-252-9927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050689K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty