| Doctor Name: | DR. MICHAEL D. WIRT |
| NPI Number: | 1639112527 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D., PH.D. |
| License Number: | N0559 |
| Business Practice Address: | 650 Joel Dr Department Of Radiology Fort Campbell, KY - 422235318 |
| Business Phone Number: | 9315427432 |
| Business Fax Number: | |
| Mailing Address: | 650 Joel Dr, Department Of Radiology FORT CAMPBELL |
| State: | KY |
| Postal Code: | 422235318 |
| Phone Number: | 9315427432 |
| Fax Number: | |
| NPI Enumeration Date: | 06/14/2006 |
| NPI Last Update Date: | 06/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | N0559 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |