Provider Demographics
NPI:1376659011
Name:KIRBY, REBECCA K (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:K
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4825 E DOUGLAS AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1017
Mailing Address - Country:US
Mailing Address - Phone:316-682-3100
Mailing Address - Fax:316-618-8537
Practice Address - Street 1:3100 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219-3904
Practice Address - Country:US
Practice Address - Phone:316-682-3100
Practice Address - Fax:316-618-8537
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0430080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00105527Medicare ID - Type UnspecifiedRR MEDICARE PROVIDER #
KS102937Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
KSF91015Medicare UPIN