Provider Demographics
NPI:1063698033
Name:KIRKWOOD, ALYSHA NICOLE (DO)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:NICOLE
Last Name:KIRKWOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:588 E LAKEWOOD BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2023
Practice Address - Country:US
Practice Address - Phone:616-494-5850
Practice Address - Fax:616-494-5901
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2015-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology