Provider Demographics
NPI:1386795847
Name:KIRK E GOLD DPM PC
Entity type:Organization
Organization Name:KIRK E GOLD DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-669-3870
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001886213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4448819Medicaid
MI0P15360Medicare PIN