Provider Demographics
NPI:1326026923
Name:KIRTLEY, XANDREA L (MD)
Entity Type:Individual
Prefix:DR
First Name:XANDREA
Middle Name:L
Last Name:KIRTLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:XANDREA
Other - Middle Name:
Other - Last Name:OXENDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1701 SOUTH BLVD E
Mailing Address - Street 2:STE 250
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-293-1002
Mailing Address - Fax:248-293-1272
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:STE 250
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-293-1002
Practice Address - Fax:248-293-1272
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301065644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110F374450OtherBCBS
MIP31222FOtherBCN
MI4097900Medicaid
G95370Medicare UPIN
MI4097900Medicaid