Provider Demographics
NPI:1245472711
Name:STEVEN P HIRSH DPM PA
Entity type:Organization
Organization Name:STEVEN P HIRSH DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HIRSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-434-6463
Mailing Address - Street 1:4611 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-434-6463
Mailing Address - Fax:954-434-6463
Practice Address - Street 1:3332 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-5519
Practice Address - Country:US
Practice Address - Phone:954-924-6151
Practice Address - Fax:954-434-6463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001789213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL029740200Medicaid
FL87973OtherB/C B/S
T55629Medicare UPIN
FL87973OtherB/C B/S
FL87973BMedicare PIN