Provider Demographics
NPI:1659655801
Name:KIRK, MICHELLE M
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:KIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FORGE PARK EAST ST.
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038
Mailing Address - Country:US
Mailing Address - Phone:508-298-1100
Mailing Address - Fax:
Practice Address - Street 1:8 FORGE MANN PARK EAST. ST.
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:MA
Practice Address - Zip Code:02038
Practice Address - Country:US
Practice Address - Phone:508-298-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program