Provider Demographics
NPI:1750806469
Name:KIRK, DEMETRIUS (RN)
Entity type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:
Last Name:KIRK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30075 SPAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-3146
Mailing Address - Country:US
Mailing Address - Phone:313-595-9010
Mailing Address - Fax:800-886-4196
Practice Address - Street 1:30075 SPAIN
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174
Practice Address - Country:US
Practice Address - Phone:313-595-9010
Practice Address - Fax:800-886-4196
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704326423163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse