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Individual

MICHAEL NELS KIRK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1000 ELEVEN S STE 4A, COLUMBIA, IL 62236-1077
(618) 206-6120
Mailing address
PO BOX 955534 SUITE 103, SAINT LOUIS, MO 63195-0001

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036091649
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036091649
IL
01
P00429606
MEDICARE RR
Enumeration date
11/10/2006
Last updated
10/23/2020
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