Provider Demographics
NPI:1639255946
Name:KIRSCHENBAUM, STUART EDWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:EDWARD
Last Name:KIRSCHENBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W GRAND BLVD STE 423
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3141
Mailing Address - Country:US
Mailing Address - Phone:313-894-5100
Mailing Address - Fax:313-894-0028
Practice Address - Street 1:3031 W GRAND BLVD STE 423
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3141
Practice Address - Country:US
Practice Address - Phone:313-894-5100
Practice Address - Fax:313-894-0028
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000622213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5825334OtherBCBSM
MI2979564Medicaid
MI2979564Medicaid
MIT34383Medicare UPIN