Individual
MR. ROBERT BIRK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
240 MAPLE ST, WOODRUFF, WI 54568-9190
(715) 356-8000
Mailing address
240 MAPLE ST, WOODRUFF, WI 54568-9190
(715) 356-8000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1515
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11014110
—
WI
01
—
1515
STATE LICENSE
WI
01
—
1851477913
CMH NPI
—
01
—
390848401050
BCBX
WI
Enumeration date
10/06/2006
Last updated
11/12/2019
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