Provider Demographics
NPI:1174509020
Name:HIRSCH, SHELDON M (MD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:M
Last Name:HIRSCH
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 1:1101 S CANAL ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4901
Mailing Address - Country:US
Mailing Address - Phone:312-986-0110
Mailing Address - Fax:312-986-1010
Practice Address - Street 1:1101 S CANAL ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4901
Practice Address - Country:US
Practice Address - Phone:312-986-0110
Practice Address - Fax:312-986-1010
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065928207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065928Medicaid
IL01621679OtherBCBS OF IL
ILA 14008Medicare UPIN
IL036065928Medicaid