MEDICARE: KEVIN S HIRSCH MD

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	2085R0202X	Diagnostic Radiology Physician	33259	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	886913	OTHER	AZ	AHCCCS
2	84772	OTHER	AZ	URL

General Provider Information

NPI Number	:	1891784849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN S HIRSCH MD

Provider Business Mailing Address
First Line	:	1111 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2612
Country	:	US
Telephone Number	:	602-239-4601
Fax Number	:	602-239-3075

Provider Business Practice Location Address
First Line	:	1111 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2612
Country	:	US
Telephone Number	:	602-239-4601
Fax Number	:	602-239-3075

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	01/09/2012

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Directions to “ KEVIN S HIRSCH MD” Practice Location

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