Provider Demographics
NPI:1578528550
Name:KIRSCH, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
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:PO BOX 27015
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-0015
Mailing Address - Country:US
Mailing Address - Phone:402-393-9459
Mailing Address - Fax:402-397-9895
Practice Address - Street 1:11602 W CENTER RD
Practice Address - Street 2:SUITE 150
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4440
Practice Address - Country:US
Practice Address - Phone:402-884-7533
Practice Address - Fax:402-884-7656
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10024951000Medicaid
NE276292Medicare ID - Type Unspecified
G87093Medicare UPIN
NE10024951000Medicaid