Provider Demographics
NPI:1467450585
Name:HIRSCH, RONALD LAUREN (MD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:LAUREN
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 1:1710 N RANDALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4717
Mailing Address - Country:US
Mailing Address - Phone:847-214-5780
Mailing Address - Fax:847-214-9606
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4717
Practice Address - Country:US
Practice Address - Phone:847-214-5780
Practice Address - Fax:847-214-9606
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081390Medicaid
IL04532170OtherBLUE CROSS BLUE SHIELD
IL04532170OtherBLUE CROSS BLUE SHIELD
IL036081390Medicaid
ILK04339Medicare ID - Type UnspecifiedLOCALITY15