Provider Demographics
NPI:1720081623
Name:KIRCHHOFF, KERRI J (MD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:J
Last Name:KIRCHHOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 NW 56TH ST, SUITE C-40
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4455
Mailing Address - Country:US
Mailing Address - Phone:405-945-4741
Mailing Address - Fax:888-972-5320
Practice Address - Street 1:3433 NW 56TH ST, SUITE C-40
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4455
Practice Address - Country:US
Practice Address - Phone:405-945-4741
Practice Address - Fax:888-972-5320
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK189502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP00144981OtherRAILROAD
OK100180830BMedicaid
OK2RADIA018Medicare ID - Type Unspecified
OK100180830BMedicaid
OKP00144981OtherRAILROAD
OK244421007Medicare ID - Type Unspecified
OKP00144981Medicare PIN
OK243719903Medicare PIN
OK242419602Medicare ID - Type Unspecified
OKMDLPL018Medicare ID - Type Unspecified