Provider Demographics
NPI:1811007636
Name:KIRSCH, ALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5192 CHILLICOTHE RD
Mailing Address - Street 2:SUITE #101
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-4196
Mailing Address - Country:US
Mailing Address - Phone:440-338-3366
Mailing Address - Fax:440-338-3332
Practice Address - Street 1:5192 CHILLICOTHE ROAD
Practice Address - Street 2:SUITE #101
Practice Address - City:SOUTH RUSSELL
Practice Address - State:OH
Practice Address - Zip Code:44022
Practice Address - Country:US
Practice Address - Phone:440-338-3366
Practice Address - Fax:440-338-3332
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-057038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0705606Medicaid
OHC03371Medicare UPIN
OH0618227Medicare PIN