Provider Demographics
NPI:1346326428
Name:HIRSH, MICHAEL S (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HIRSH
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 1:3217 STEIN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6995
Mailing Address - Country:US
Mailing Address - Phone:715-835-6548
Mailing Address - Fax:715-835-7708
Practice Address - Street 1:3203 STEIN BOULEVARD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6995
Practice Address - Country:US
Practice Address - Phone:715-835-6548
Practice Address - Fax:715-835-7708
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39977208800000X
MN42190208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI59889OtherSECURITY HEALTH PLAN
WI19-00545OtherMEDICA
WI32542000Medicaid
WI340000691OtherWAUSAU INSURANCE
MN3490653-00Medicaid
MN19-00548OtherMEDICA
WI208D1HIOtherHMO OF WISCONSIN
WI340000691OtherWAUSAU INSURANCE
MN3490653-00Medicaid