Provider Demographics
NPI:1821194846
Name:BIRT, CAROL MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:BIRT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W 6TH ST, UNIT E-1
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049
Mailing Address - Country:US
Mailing Address - Phone:239-247-1313
Mailing Address - Fax:
Practice Address - Street 1:2600 W 6TH ST
Practice Address - Street 2:UNIT E-1
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4318
Practice Address - Country:US
Practice Address - Phone:239-247-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 888742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0423511OtherPROFESSIONAL LICENSE
KS0423511OtherPROFESSIONAL LICENSE