Provider Demographics
NPI:1558557363
Name:HIRT, JAMES ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:HIRT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14229 TORREY RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3308
Mailing Address - Country:US
Mailing Address - Phone:810-629-3338
Mailing Address - Fax:810-629-9243
Practice Address - Street 1:14229 TORREY RD
Practice Address - Street 2:SUITE #1
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3308
Practice Address - Country:US
Practice Address - Phone:810-629-3338
Practice Address - Fax:810-629-9243
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-15
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002200213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01011731OtherHEALTHPLUS
MI1558557363Medicaid
MI4852512480OtherBLUE CROSS BLUE SHIELD
MI4852512480OtherBLUE CROSS BLUE SHIELD
MI6090250001Medicare NSC