Provider Demographics
NPI:1861595753
Name:FIRE, KEVIN MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:FIRE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 NORTH WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3400
Mailing Address - Country:US
Mailing Address - Phone:701-787-5862
Mailing Address - Fax:701-738-2371
Practice Address - Street 1:121 NORTH WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3400
Practice Address - Country:US
Practice Address - Phone:701-787-5862
Practice Address - Fax:701-738-2371
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND441231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND51100Medicaid
NDFIR19598OtherBCBS
MN1G724FIOtherBCBS
NDFIR19598OtherBCBS
R02380Medicare UPIN