Provider Demographics
NPI:1295990950
Name:KIRSCH, LEE ALAN (DO)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ALAN
Last Name:KIRSCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 SW 89TH ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159
Mailing Address - Country:US
Mailing Address - Phone:405-378-3300
Mailing Address - Fax:405-378-3993
Practice Address - Street 1:3212 SW 89TH ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159
Practice Address - Country:US
Practice Address - Phone:405-378-3300
Practice Address - Fax:405-378-3993
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4655207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4655OtherOKLAHOMA STATE BOARD OF OSTEOPATHIC EXAMINERS