Provider Demographics
NPI:1376602300
Name:KIRSCH, MICHAEL ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLAN
Last Name:KIRSCH
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 1:4529 SHERMAN OAKS AVENUE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3820
Mailing Address - Country:US
Mailing Address - Phone:818-986-8193
Mailing Address - Fax:818-986-7133
Practice Address - Street 1:4529 SHERMAN OAKS AVENUE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3820
Practice Address - Country:US
Practice Address - Phone:818-986-8193
Practice Address - Fax:818-986-7133
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12156207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W517Medicare ID - Type Unspecified
A38565Medicare UPIN