Provider Demographics
NPI:1407819600
Name:BIROS, KENNETH J (DO)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:BIROS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9164 RUBY RIDGE ST NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8795
Mailing Address - Country:US
Mailing Address - Phone:330-854-1892
Mailing Address - Fax:330-776-5557
Practice Address - Street 1:9164 RUBY RIDGE ST NW
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-8795
Practice Address - Country:US
Practice Address - Phone:330-854-1892
Practice Address - Fax:330-776-5557
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003948207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0707417Medicaid
OHBI0576772Medicare PIN
OHE00774Medicare UPIN