Provider Demographics
NPI:1033483011
Name:KIRSCH MEDICAL AESTHETIC ASSOCIATES
Entity Type:Organization
Organization Name:KIRSCH MEDICAL AESTHETIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-884-7533
Mailing Address - Street 1:11623 ARBOR ST STE 101
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2996
Mailing Address - Country:US
Mailing Address - Phone:402-884-7533
Mailing Address - Fax:402-884-0609
Practice Address - Street 1:11623 ARBOR ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2996
Practice Address - Country:US
Practice Address - Phone:402-884-7533
Practice Address - Fax:402-884-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-08
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty