Provider Demographics
NPI:1245347251
Name:MUFFLY, KIRK B (MD)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:B
Last Name:MUFFLY
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 1:7100 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2700
Mailing Address - Country:US
Mailing Address - Phone:402-506-9108
Mailing Address - Fax:402-858-7108
Practice Address - Street 1:7100 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2700
Practice Address - Country:US
Practice Address - Phone:402-506-9108
Practice Address - Fax:402-858-7108
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15452207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB67863Medicare UPIN
IA2936948Medicaid
NEB67863Medicare UPIN
NE278159Medicare ID - Type Unspecified