Provider Demographics
NPI:1689619587
Name:KIRK E MAES M D P A
Entity Type:Organization
Organization Name:KIRK E MAES M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:MAES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-581-5881
Mailing Address - Street 1:13000 US HIGHWAY 1
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3773
Mailing Address - Country:US
Mailing Address - Phone:772-581-5881
Mailing Address - Fax:772-581-5883
Practice Address - Street 1:13000 US HIGHWAY 1
Practice Address - Street 2:SUITE 5
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3773
Practice Address - Country:US
Practice Address - Phone:772-581-5881
Practice Address - Fax:772-581-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00078507207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257656200Medicaid
FL4254710001Medicare NSC
FL46869YMedicare PIN
FLK2116AMedicare PIN
FL257656200Medicaid