Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208800000X | Urologist | 01055523A | IN |
Y | 208800000X | Urologist | 4301077717 | MI |
NPI | 1013980697 |
---|---|
Provider Name | Kent A Kirby |
First Address | Chicago, IL 60677-5316 |
Second Address | Mt. Pleasant, MI 48858-3057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 08/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200915390 | (05) | IN |