Provider Demographics
NPI:1619040623
Name:MILLER, KIRK A (DO)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:DO
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 411851
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1851
Mailing Address - Country:US
Mailing Address - Phone:913-588-6805
Mailing Address - Fax:913-588-7899
Practice Address - Street 1:3901 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-7234
Practice Address - Country:US
Practice Address - Phone:913-588-6805
Practice Address - Fax:913-588-7899
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05313782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS104885OtherBCBS
KS200357580AMedicaid
KS105884Medicare ID - Type Unspecified
I45243Medicare UPIN