Provider Demographics
NPI:1033147558
Name:HIRSCHLER, RICHARD A (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:HIRSCHLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5515 CLEVELAND AVENUE
Mailing Address - Street 2:SUUITE 6
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127
Mailing Address - Country:US
Mailing Address - Phone:269-429-9677
Mailing Address - Fax:269-429-4002
Practice Address - Street 1:5515 CLEVELAND AVENUE
Practice Address - Street 2:SUUITE 6
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127
Practice Address - Country:US
Practice Address - Phone:269-429-9677
Practice Address - Fax:269-429-4002
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029501174400000X
IN01029311A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4758016Medicaid
CIGNAOther4840301
MIBLUE CROSSOther101110742
MIPHPOther01-31419
MI4886571Medicaid
MIB28912Medicare UPIN
CIGNAOther4840301