Provider Demographics
NPI:1912294174
Name:PATRICIA A. KIRK DPM, PLLC
Entity Type:Organization
Organization Name:PATRICIA A. KIRK DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-229-8965
Mailing Address - Street 1:16682 N WEST POINT PKWY
Mailing Address - Street 2:APT. 281
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4033
Mailing Address - Country:US
Mailing Address - Phone:623-229-8965
Mailing Address - Fax:
Practice Address - Street 1:16682 N WEST POINT PKWY
Practice Address - Street 2:APT. 281
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4033
Practice Address - Country:US
Practice Address - Phone:623-229-8965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0717213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty