Provider Demographics
NPI:1942348446
Name:HERRICK, KIRK H (DO)
Entity Type:Individual
Prefix:MR
First Name:KIRK
Middle Name:H
Last Name:HERRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3216 CHRISTY WAY S
Mailing Address - Street 2:SUITE#1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2214
Mailing Address - Country:US
Mailing Address - Phone:989-498-3438
Mailing Address - Fax:989-799-0320
Practice Address - Street 1:3216 CHRISTY WAY S
Practice Address - Street 2:SUITE#1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2214
Practice Address - Country:US
Practice Address - Phone:989-498-3438
Practice Address - Fax:989-799-0320
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2014-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101004727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4332386Medicaid
MI174211560OtherPPOM
MI5730741OtherBCBS
B44251Medicare UPIN
MI4332386Medicaid