Provider Demographics
NPI:1386620730
Name:WOJNO, KIRK J (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:J
Last Name:WOJNO
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 1:5100 TALLEY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-8040
Mailing Address - Country:US
Mailing Address - Phone:501-500-6640
Mailing Address - Fax:
Practice Address - Street 1:1310 N STEPHENSON HWY STE 300
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1508
Practice Address - Country:US
Practice Address - Phone:601-500-6767
Practice Address - Fax:248-336-3395
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062774207ZP0104X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4642745Medicaid
F27340Medicare UPIN