Provider Demographics
NPI:1821071291
Name:SHIBLEY, KIRK ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:ANTHONY
Last Name:SHIBLEY
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 1:6565 FRANCE AVE S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2137
Mailing Address - Country:US
Mailing Address - Phone:952-920-2200
Mailing Address - Fax:950-920-0866
Practice Address - Street 1:6565 FRANCE AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2137
Practice Address - Country:US
Practice Address - Phone:952-920-2200
Practice Address - Fax:950-920-0866
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN36419207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN063065900Medicaid
MN063065900Medicaid
MN063065900Medicaid