Provider Demographics
NPI:1740202977
Name:HIRSCH, KEVIN J (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2010 59TH ST W
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-4616
Mailing Address - Country:US
Mailing Address - Phone:941-794-5621
Mailing Address - Fax:941-761-1532
Practice Address - Street 1:2010 59TH ST W
Practice Address - Street 2:SUITE 2200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4616
Practice Address - Country:US
Practice Address - Phone:941-794-5621
Practice Address - Fax:941-761-1532
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 625702086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371618000Medicaid
FL18210Medicare ID - Type Unspecified