Provider Demographics
NPI:1427387893
Name:HIRSCH, ALAN R (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:R
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 1:1455 E GOLF RD STE 207
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1254
Mailing Address - Country:US
Mailing Address - Phone:312-649-5829
Mailing Address - Fax:847-376-8211
Practice Address - Street 1:1455 E GOLF RD STE 207
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1254
Practice Address - Country:US
Practice Address - Phone:312-649-5829
Practice Address - Fax:847-376-8211
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.062361174400000X
IL0360623612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15142Medicare UPIN