Provider Demographics
NPI:1780687905
Name:KIRK, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:KIRK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E PARRISH AVE
Mailing Address - Street 2:STE 450
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3223
Mailing Address - Country:US
Mailing Address - Phone:270-685-3700
Mailing Address - Fax:270-685-0998
Practice Address - Street 1:815 E PARRISH AVE
Practice Address - Street 2:STE 450
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3223
Practice Address - Country:US
Practice Address - Phone:270-685-3700
Practice Address - Fax:270-685-0998
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2010-01-13
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
KY29104207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64291040Medicaid
IN100028040Medicaid
KYK011431OtherCHAMPUS
KY000000049966OtherBCBS 12 DIGIT
KY1463195OtherUMWA
KY1064356Medicaid
KY18B4OtherBCBS 4 DIGIT
KY272388OtherHEALTHLINK
KY18B4OtherBCBS 4 DIGIT
KYK011431OtherCHAMPUS
KY1064356Medicaid