Provider Demographics
NPI:1356778161
Name:HIRSH, KYLE (DO)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:HIRSH
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 1:7220 MIRA VISTA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3025
Mailing Address - Country:US
Mailing Address - Phone:702-371-1187
Mailing Address - Fax:
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5154
Practice Address - Country:US
Practice Address - Phone:970-810-4121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10504179-1204207R00000X
CODR0057213207R00000X
ORDO187636207R00000X
AZ008320207R00000X
OK7134207R00000X
SD10908207R00000X
IDOC-0024207R00000X
NVDO2162207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDO187636OtherOREGON MEDICAL LICENSE
UT10504179-1204OtherUTAH MEDICAL LICENSE
NVDO2162OtherNEVADA OSTEOPATHIC LICENSE
IDOC-0024OtherIDAHO MEDICAL LICENSE
SD10908OtherSOUTH DAKOTA MEDICAL LICENSE
CODR0057213OtherCOLORADO MEDICAL LICENSE