Provider Demographics
NPI:1982818431
Name:CARRUTHERS, KIRK ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:ANTHONY
Last Name:CARRUTHERS
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 1:1670 UPHAM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1250
Mailing Address - Country:US
Mailing Address - Phone:614-293-9600
Mailing Address - Fax:
Practice Address - Street 1:1670 UPHAM DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1250
Practice Address - Country:US
Practice Address - Phone:614-293-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57 . 0116752084P0800X
OH35.0954032084P0800X
TN479802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry