1033147558 NPI number — DR. RICHARD A HIRSCHLER MD

Table of content: DR. RICHARD A HIRSCHLER MD (NPI 1033147558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033147558 NPI number — DR. RICHARD A HIRSCHLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HIRSCHLER
Provider First Name:
RICHARD
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033147558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5515 CLEVELAND AVENUE
Provider Second Line Business Mailing Address:
SUUITE 6
Provider Business Mailing Address City Name:
STEVENSVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-429-9677
Provider Business Mailing Address Fax Number:
269-429-4002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5515 CLEVELAND AVENUE
Provider Second Line Business Practice Location Address:
SUUITE 6
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-429-9677
Provider Business Practice Location Address Fax Number:
269-429-4002
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301029501 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 01029311A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4758016 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: CIGNA . This is a "4840301" identifier . This identifiers is of the category "OTHER".
  • Identifier: BLUE CROSS . This is a "101110742" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: PHP . This is a "01-31419" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4886571 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com