Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PO967 | FL |
NPI | 1366448235 |
---|---|
Provider Name | Dr. Robert Terry Kirschenbaum |
First Address | Altamonte Springs, FL 32714-7014 |
Second Address | Altamonte Springs, FL 32714-7014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2005 |
Last Update Date | 22/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041256200 | (05) | FL |
0955000001 | MEDICARE DMERC 2ND LOCAL (01) | FL |
1366448235 | MEDICARE DMERC (01) | FL |
T88559 | (02) | |
T88559 | (02) | FL |