Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 019015576 | IL |
NPI | 1003948555 |
---|---|
Provider Name | Dr. Martin Alan Hirsch |
First Address | Winnetka, IL 60093-1313 |
Second Address | Chicago, IL 60657-6156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2007 |
Last Update Date | 08/04/2011 |