Provider Demographics
NPI:1508857806
Name:KIRSCH, ILANA TAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:TAMIR
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 UNIVERSITY COMMONS STE 210
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1590
Mailing Address - Country:US
Mailing Address - Phone:574-234-4016
Mailing Address - Fax:574-239-4607
Practice Address - Street 1:6301 UNIVERSITY COMMONS STE 210
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635
Practice Address - Country:US
Practice Address - Phone:574-234-4016
Practice Address - Fax:574-239-4607
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054274A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200349210Medicaid
INM40061771OtherMEDICARE PTAN
IN200349210Medicaid