Provider Demographics
NPI:1083661789
Name:DANIEL J. HIRSEN, M.D.,LLC
Entity Type:Organization
Organization Name:DANIEL J. HIRSEN, M.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HIRSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-424-9353
Mailing Address - Street 1:PO BOX 7389
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-7389
Mailing Address - Country:US
Mailing Address - Phone:847-870-3600
Mailing Address - Fax:847-870-3500
Practice Address - Street 1:10330 S ROBERTS RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PALOS HILLS
Practice Address - State:IL
Practice Address - Zip Code:60465-1971
Practice Address - Country:US
Practice Address - Phone:708-233-5644
Practice Address - Fax:708-425-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID NUMBER
IL213856Medicare PIN