Provider Demographics
NPI:1619954021
Name:KIRKPATRICK, DAVID DALE III (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DALE
Last Name:KIRKPATRICK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1270 SOLUTIONS CENTER
Mailing Address - Street 2:P.O. BOX 771270
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1002
Mailing Address - Country:US
Mailing Address - Phone:513-542-6898
Mailing Address - Fax:513-542-7972
Practice Address - Street 1:7502 STATE RD
Practice Address - Street 2:STE. 1180
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-2800
Practice Address - Country:US
Practice Address - Phone:513-232-8181
Practice Address - Fax:513-624-2956
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053895208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000020983OtherANTHEM
OH020034066OtherRAILROAD MEDICARE
OH0646831Medicaid
OH0646689OtherAETNA
OH742489OtherBUCKEYE
OH299862OtherAMERIGROUP
OH299862OtherAMERIGROUP
OHC03118Medicare UPIN
OHKI0589385Medicare PIN