Individual provider Active NPI

Justin K Kirkham, MD, PHD

  • Pediatric Hematology & Oncology Physician
  • Duluth, MN
National Provider Identifier
1477085074
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
64122 Issued in MN
Practice address
420 E 1St St
Duluth, MN 55805-1901
Phone
(218) 786-8364
NPI assigned
Apr 1, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 64122 MN
Pediatric Hematology & Oncology Physician 2080P0207X 64122 MN Primary

Addresses

Primary practice location

420 E 1St St
Duluth, MN 55805-1901

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-6454

Other practice location 1

262 Danny Thomas Pl
Memphis, TN 38105-3678
Phone (888) 226-4343

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180820001364 MN Practitioner - Pediatric Medicine 4688946924 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Connecticut School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

420 E 1St St
Duluth, MN 55805-1901
Phone (218) 786-8364

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
64122MNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD CurrentSince Aug 28, 2023 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Aug 28, 2023 Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

420 E 1st St
Duluth, MN 55805
Phone (218) 786-1265

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1477085074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 E 1ST ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051901",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "262 Danny Thomas Pl",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381053678",
            "country_code": "US",
            "telephone_number": "888-226-4343",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIRKHAM",
        "first_name": "JUSTIN",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-01",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "64122",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "MN",
            "license": "64122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.