Provider Demographics
NPI:1912936212
Name:KIRK, CARY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:THOMAS
Last Name:KIRK
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:PO BOX 8180
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-8180
Mailing Address - Country:US
Mailing Address - Phone:502-753-0680
Mailing Address - Fax:502-753-0687
Practice Address - Street 1:4950 NORTON HEALTHCARE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2845
Practice Address - Country:US
Practice Address - Phone:502-446-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21368208D00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50012968OtherPASSPORT HEALTH PLANS
KY000000487847OtherANTHEM BLUE CROSS BLUE SHIELD
KYDF7517OtherRAILROAD MEDICARE
IN200828020AMedicaid
KY2789404000OtherPASSPORT ADVANTAGE
KY7100047430Medicaid
TNC64349Medicare UPIN
KY7100047430Medicaid