Provider Demographics
NPI:1073558102
Name:KIRCHHAINE, WILLIAM F JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:F
Last Name:KIRCHHAINE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 W NORTON AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-6526
Mailing Address - Country:US
Mailing Address - Phone:231-739-7334
Mailing Address - Fax:
Practice Address - Street 1:747 W NORTON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-6526
Practice Address - Country:US
Practice Address - Phone:231-739-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049279208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104517658Medicaid
MIE30928Medicare UPIN
MI0616223Medicare ID - Type Unspecified