Provider Demographics
NPI:1851592935
Name:MICHIANA UROLOGY PC
Entity Type:Organization
Organization Name:MICHIANA UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-695-3897
Mailing Address - Street 1:804 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BUCHANAN
Mailing Address - State:MI
Mailing Address - Zip Code:49107-1444
Mailing Address - Country:US
Mailing Address - Phone:269-695-3897
Mailing Address - Fax:269-695-0460
Practice Address - Street 1:804 E FRONT ST
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:MI
Practice Address - Zip Code:49107-1444
Practice Address - Country:US
Practice Address - Phone:269-695-3897
Practice Address - Fax:269-695-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077717208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty