Provider Demographics
NPI:1649735184
Name:KIRSCH, NICHOLAS JOSHUA
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOSHUA
Last Name:KIRSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 BLACKSTONE PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4903
Mailing Address - Country:US
Mailing Address - Phone:847-772-3303
Mailing Address - Fax:
Practice Address - Street 1:671 BLACKSTONE PL
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4903
Practice Address - Country:US
Practice Address - Phone:847-772-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer