Provider Demographics
NPI:1124108980
Name:KIRKLAND, JEANNE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:MARIE
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5928 SPRINGBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3250
Mailing Address - Country:US
Mailing Address - Phone:937-433-0220
Mailing Address - Fax:937-433-0623
Practice Address - Street 1:5928 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3250
Practice Address - Country:US
Practice Address - Phone:937-433-0220
Practice Address - Fax:937-434-4405
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH45543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC02158Medicare UPIN
OH0501872Medicare PIN