Individual
GERALD A KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 W 86TH ST, INDIANAPOLIS, IN 46260-1902
(317) 567-2180
(317) 567-2191
Mailing address
PO BOX 7232, DEPT 165, INDIANAPOLIS, IN 46207-7232
(317) 567-2180
(317) 567-2191
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01040761
IN
207L00000X
Anesthesiology Physician
26042
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100121770
—
IN
01
—
70403
WELLMARK BCBS
IA
Enumeration date
11/18/2005
Last updated
12/03/2009
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