Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12013010A | IN |
Y | 213EG0000X | General Practice | 12013010A | IN |
NPI | 1003394438 |
---|---|
Provider Name | Dr. Trent Kirkwood |
First Address | Greenfield, IN 46140-2177 |
Second Address | Greenfield, IN 46140-2177 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2018 |
Last Update Date | 28/07/2018 |