Provider Demographics
NPI:1962487611
Name:WINWARD, KIRK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:EDWARD
Last Name:WINWARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5169 COTTONWOOD ST STE 630
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6771
Mailing Address - Country:US
Mailing Address - Phone:801-281-3030
Mailing Address - Fax:801-281-3033
Practice Address - Street 1:5169 COTTONWOOD ST STE 630
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-6771
Practice Address - Country:US
Practice Address - Phone:801-281-3030
Practice Address - Fax:801-281-3033
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT187019 1205207W00000X
UT187019-1205207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
005545102OtherMEDICARE
180013350OtherRAILROAD MEDICARE
ID00341000OtherMEDICAID
870525682OtherTAX ID #
005584702OtherMEDICARE
WY104743400OtherMEDICAID
000010486OtherMEDICARE
005545202OtherMEDICARE
005584702OtherMEDICARE
E89299Medicare UPIN