Provider Demographics
NPI:1720079684
Name:BAXTER, KIRKMAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRKMAN
Middle Name:G
Last Name:BAXTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26035
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON, INC
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-6035
Mailing Address - Country:US
Mailing Address - Phone:330-493-0840
Mailing Address - Fax:330-493-7123
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF CANTON, INC - ATTN: CECILIA
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-2842
Practice Address - Fax:330-580-5536
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35 0774952085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2193255Medicaid
OH300136937OtherRAILROAD MEDICARE
OH300112746OtherRAILROAD MEDICARE
OHP00396876OtherRAILROAD MEDICARE
OHP00396876OtherRAILROAD MEDICARE
OH4017147Medicare PIN
OH300112746OtherRAILROAD MEDICARE
OHC37267Medicare UPIN
OH2193255Medicaid