Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019.027911 | IL |
NPI | 1003041799 |
---|---|
Provider Name | Dr. Michael Edward Kirsch JR. |
First Address | Orland Park, IL 60462-5393 |
Second Address | Orland Park, IL 60462-5393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2009 |
Last Update Date | 25/05/2009 |