Healthcare Provider Details

I. General information

NPI: 1245472711
Provider Name (Legal Business Name): STEVEN P HIRSH DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 GRIFFIN RD
FORT LAUDERDALE FL
33312-5519
US

IV. Provider business mailing address

4611 S UNIVERSITY DR SUITE 225
DAVIE FL
33328-3817
US

V. Phone/Fax

Practice location:
  • Phone: 954-924-6151
  • Fax: 954-434-6463
Mailing address:
  • Phone: 954-434-6463
  • Fax: 954-434-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO0001789
License Number StateFL

VIII. Authorized Official

Name: DR. STEVEN P HIRSH
Title or Position: PRESIDENT
Credential:
Phone: 954-434-6463