Provider Demographics
NPI:1821107848
Name:KIRBY, AMY MARIE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:44555 WOODWARD AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-338-7171
Mailing Address - Fax:248-858-3889
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-338-7171
Practice Address - Fax:248-858-3889
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAK070384208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4415961Medicaid
MIP17040002Medicare ID - Type Unspecified
H63546Medicare UPIN