Healthcare Provider Details

I. General information

NPI: 1306836754
Provider Name (Legal Business Name): WILLIAM DAVID KIRSH DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 BISCAYNE BLVD SUITE 211
NORTH MIAMI FL
33181-2735
US

IV. Provider business mailing address

12000 BISCAYNE BLVD SUITE 211
MIAMI FL
33181-4234
US

V. Phone/Fax

Practice location:
  • Phone: 305-534-9200
  • Fax: 305-534-0190
Mailing address:
  • Phone: 305-534-9200
  • Fax: 305-534-0190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOS 0005077
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: