MEDICARE: DR. MICHAEL HIRT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G81062	CA

General Provider Information

NPI Number	:	1639279292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL HIRT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 572164
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91357-2164
Country	:	US
Telephone Number	:	818-345-2828
Fax Number	:	818-345-2848

Provider Business Practice Location Address
First Line	:	5620 WILBUR AVE
Second Line	:	SUITE 220
City	:	TARZANA
State	:	CA
Zip	:	91356-1351
Country	:	US
Telephone Number	:	818-345-2828
Fax Number	:	818-345-2848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	07/08/2007

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