Provider Demographics
NPI:1821063363
Name:HIRTH, JOANN (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:HIRTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1847
Mailing Address - Country:US
Mailing Address - Phone:517-205-1594
Mailing Address - Fax:517-205-1540
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1847
Practice Address - Country:US
Practice Address - Phone:517-205-1594
Practice Address - Fax:517-205-1540
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIJH061550207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4618042Medicaid
N81810006Medicare ID - Type Unspecified
MIG54628Medicare UPIN