Provider Demographics
NPI:1154367084
Name:KIRKBY, CHERYL K (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:K
Last Name:KIRKBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:K
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17853 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-8520
Mailing Address - Country:US
Mailing Address - Phone:937-578-4210
Mailing Address - Fax:937-578-4220
Practice Address - Street 1:17853 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-8520
Practice Address - Country:US
Practice Address - Phone:937-578-4210
Practice Address - Fax:937-578-4220
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.079973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2777713Medicaid
OH000000216528OtherANTHEM BC/BS