Provider Demographics
NPI:1104880269
Name:GOLD, KIRK EDWARD (DPM)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:EDWARD
Last Name:GOLD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 E WEST MAPLE RD
Mailing Address - Street 2:SUITE B-207
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3816
Mailing Address - Country:US
Mailing Address - Phone:248-669-3870
Mailing Address - Fax:248-669-3866
Practice Address - Street 1:2075 E WEST MAPLE RD
Practice Address - Street 2:SUITE B-207
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-3816
Practice Address - Country:US
Practice Address - Phone:248-669-3870
Practice Address - Fax:248-669-3866
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKG001886213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4448819Medicaid
MIU67916Medicare UPIN
MI0P15360Medicare PIN