Provider Demographics
NPI:1205861853
Name:HIRE, ERVIN A JR (MD)
Entity Type:Individual
Prefix:
First Name:ERVIN
Middle Name:A
Last Name:HIRE
Suffix:JR
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 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 185
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-3390
Mailing Address - Fax:231-487-3578
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 185
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-3390
Practice Address - Fax:231-487-3578
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036625174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4432336Medicaid
MIB04285Medicare UPIN
MIN56640001Medicare ID - Type Unspecified