Provider Demographics
NPI:1003011529
Name:BIRKY, JOHN CHRISTIAN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:BIRKY
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 1:902 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5640
Mailing Address - Country:US
Mailing Address - Phone:620-277-8676
Mailing Address - Fax:620-464-4732
Practice Address - Street 1:311 E SPRUCE ST
Practice Address - Street 2:STE 2B
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5614
Practice Address - Country:US
Practice Address - Phone:620-765-4324
Practice Address - Fax:620-464-4732
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33089207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200567860CMedicaid
KS200567860CMedicaid