Provider Demographics
NPI:1922097492
Name:KIRKNER, STEPHEN L (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:KIRKNER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1111 TENEYCK ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2461
Mailing Address - Country:US
Mailing Address - Phone:517-787-8940
Mailing Address - Fax:517-787-9054
Practice Address - Street 1:1111 TENEYCK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2461
Practice Address - Country:US
Practice Address - Phone:517-787-8940
Practice Address - Fax:517-787-9054
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007908207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISK007908OtherLICENSE NUMBER
MI1359429OtherFIRST HEALTH
MI5284809OtherAETNA
MI0453800108OtherBLUE CROSS
MI3488032Medicaid
MI5284809OtherAETNA
MI1359429OtherFIRST HEALTH