Provider Demographics
NPI:1003180852
Name:HIRSCH, KYLE MATTHEW
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:MATTHEW
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 N HARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-3017
Mailing Address - Country:US
Mailing Address - Phone:405-525-3959
Mailing Address - Fax:405-525-7867
Practice Address - Street 1:2619 N HARVEY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3017
Practice Address - Country:US
Practice Address - Phone:405-525-3959
Practice Address - Fax:405-525-7867
Is Sole Proprietor?:No
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator