Provider Demographics
NPI:1609818343
Name:MAES, KIRK EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:EDWIN
Last Name:MAES
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 1:13000 US HIGHWAY 1
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3773
Mailing Address - Country:US
Mailing Address - Phone:772-581-5881
Mailing Address - Fax:772-581-5883
Practice Address - Street 1:13000 US HIGHWAY 1
Practice Address - Street 2:SUITE 5
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3773
Practice Address - Country:US
Practice Address - Phone:772-581-5881
Practice Address - Fax:772-581-5883
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00078507207XX0005X
FLME78507207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257656200Medicaid
FL46869AMedicare ID - Type Unspecified
FL257656200Medicaid