Provider Demographics
NPI:1467747774
Name:MICHAEL J KIRBY MD PLC
Entity Type:Organization
Organization Name:MICHAEL J KIRBY MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-750-6060
Mailing Address - Street 1:445 N FENWAY DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2666
Mailing Address - Country:US
Mailing Address - Phone:810-750-6060
Mailing Address - Fax:810-750-6081
Practice Address - Street 1:445 N FENWAY DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2666
Practice Address - Country:US
Practice Address - Phone:810-750-6060
Practice Address - Fax:810-750-6081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080170208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty