Provider Demographics
NPI:1467491654
Name:STIFFLER, KIRK (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:STIFFLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1649
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44309-1649
Mailing Address - Country:US
Mailing Address - Phone:330-864-8900
Mailing Address - Fax:330-869-8924
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-3369
Practice Address - Fax:330-375-3769
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350691935207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH61641OtherUNITED HEALTHCARE
OH000000138488OtherANTHEM
OH0226580Medicaid
OH341779226002OtherMED MUT OF OH/ 1 OF 2
OH930053207OtherRR MEDICARE
OH341779226003OtherMED MUT OF OH/ 2 OF 2
OH341779226KSTOtherSUMMACARE
OH930053207OtherRR MEDICARE
OH61641OtherUNITED HEALTHCARE
OH0226580Medicaid