Provider Demographics
NPI:1861550667
Name:KIRSCHKE, DAVID LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LOUIS
Last Name:KIRSCHKE
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 1:729 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6503
Mailing Address - Country:US
Mailing Address - Phone:423-914-0840
Mailing Address - Fax:
Practice Address - Street 1:1233 SOUTHWEST AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6596
Practice Address - Country:US
Practice Address - Phone:423-979-3200
Practice Address - Fax:423-979-3267
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMDF37315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNGF6030Medicare UPIN