# DR. KENT ALAN KIRK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1154340941
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 036070489 | IL | Yes |

## Other

- **Enumeration date:** 07/19/2006
- **Last updated:** 04/04/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1607956 | BC/BS ILLINOIS | IL |
| 05 | — | 36070489 | — | IL |
| 01 | — | 362658561 | FED TAX ID \# | IL |