Provider Demographics
NPI:1275508269
Name:HIRSCH, NED BRODER (DPM)
Entity Type:Individual
Prefix:
First Name:NED
Middle Name:BRODER
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30750 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1589
Mailing Address - Country:US
Mailing Address - Phone:248-568-2470
Mailing Address - Fax:
Practice Address - Street 1:30750 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1589
Practice Address - Country:US
Practice Address - Phone:248-568-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001791213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI480F372880OtherBLUE CROSS BLUE SHIELD
MI3394419Medicaid
MI480023913OtherRAILROAD MEDICARE
MI3394419Medicaid
MI0F37288022Medicare PIN
MI480F372880OtherBLUE CROSS BLUE SHIELD