Provider Demographics
NPI:1639146327
Name:WITHROW, KIRK
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:WITHROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26445207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051529444OtherBLUE CROSS BLUE SHIELD
AL051548662OtherBCBS
AL051548669OtherBCBS
AL101712Medicaid
AL101714Medicaid
AL051548671OtherBCBS
AL101710Medicaid
P00653648OtherRAILROAD MEDICARE
AL051548670OtherBCBS
AL101712Medicaid
AL051548669OtherBCBS
AL101714Medicaid
AL510I040005Medicare PIN