Provider Demographics
NPI:1871686782
Name:KIRK, TIMOTHY A (DPM)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:A
Last Name:KIRK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5TH AND MONTGOMERY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-1300
Mailing Address - Country:US
Mailing Address - Phone:610-367-7000
Mailing Address - Fax:610-367-4559
Practice Address - Street 1:5TH AND MONTGOMERY
Practice Address - Street 2:SUITE 102
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-1300
Practice Address - Country:US
Practice Address - Phone:610-367-7000
Practice Address - Fax:610-367-4559
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004605L213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50074067OtherCAPITAL BLUE CROSS
PA2400406000OtherINDEPENDENCE BLUE CROSS
PA1732823OtherHIGHMARK BLUE SHIELD
PA2400406OtherAMERIHEALTH
PA50074067OtherCAPITAL BLUE CROSS
U95764Medicare UPIN
PA6075530001Medicare NSC
PA2400406OtherAMERIHEALTH
NJ091421Medicare ID - Type Unspecified