Healthcare Provider Details

I. General information

NPI: 1083661789
Provider Name (Legal Business Name): DANIEL J. HIRSEN, M.D.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 S ROBERTS RD 2ND FLOOR
PALOS HILLS IL
60465-1971
US

IV. Provider business mailing address

PO BOX 7389
PROSPECT HEIGHTS IL
60070-7389
US

V. Phone/Fax

Practice location:
  • Phone: 708-233-5644
  • Fax: 708-425-3907
Mailing address:
  • Phone: 847-870-3600
  • Fax: 847-870-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name: DANIEL J HIRSEN
Title or Position: DIRECTOR
Credential: M.D.
Phone: 708-424-9353