Provider Demographics
NPI:1740368620
Name:KIRSCH, ARCHIE P (MD)
Entity type:Individual
Prefix:MR
First Name:ARCHIE
Middle Name:P
Last Name:KIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:514 IDAHO DR
Mailing Address - City:MEDICINE BOW
Mailing Address - State:WY
Mailing Address - Zip Code:82329-0037
Mailing Address - Country:US
Mailing Address - Phone:307-379-2222
Mailing Address - Fax:307-379-2223
Practice Address - Street 1:514 IDAHO DR
Practice Address - Street 2:
Practice Address - City:MEDICINE BOW
Practice Address - State:WY
Practice Address - Zip Code:82329-0037
Practice Address - Country:US
Practice Address - Phone:307-379-2222
Practice Address - Fax:307-379-2223
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2106A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY2166OtherBCBS
WY533803Medicare ID - Type Unspecified
A73197Medicare UPIN