Individual
KIRK D DIMITRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1110 KEPLER DR, GREEN BAY, WI 54311-8306
(920) 288-5555
(920) 288-5550
Mailing address
1035 KEPLER DR, GREEN BAY, WI 54311-8320
(920) 490-9046
(920) 405-8005
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
35.085490
OH
207X00000X
Orthopaedic Surgery Physician
Primary
52604-020
WI
207X00000X
Orthopaedic Surgery Physician
ME100953
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518020429
BCBS
WI
05
—
207X00000X
—
WI
01
—
390806395003
CHAMPUS
WI
Enumeration date
12/19/2006
Last updated
04/21/2026
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