Provider Demographics
NPI:1609950385
Name:SHULKE, KIRK (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:SHULKE
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 62022
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77205
Mailing Address - Country:US
Mailing Address - Phone:616-734-0335
Mailing Address - Fax:616-949-8540
Practice Address - Street 1:4401 GARTH RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-420-8600
Practice Address - Fax:281-837-8282
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8974207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138985009Medicaid
TX138985009Medicaid
TX85136JMedicare PIN