Provider Demographics
NPI:1366425076
Name:DOERGER, KIRK M (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:M
Last Name:DOERGER
Suffix:
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:PO BOX 932163
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-2501
Mailing Address - Country:US
Mailing Address - Phone:586-412-4365
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-2160
Practice Address - Fax:859-301-3932
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY391982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00230222OtherRRMC
OH2699245Medicaid
KY64106883Medicaid
KY1269646Medicare PIN
KY64106883Medicaid
P00230222OtherRRMC