Healthcare Provider Details

I. General information

NPI: 1477636892
Provider Name (Legal Business Name): SCOTT D HIRSH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 MAYFIELD RD SUITE 323
MAYFIELD HTS OH
44124-2299
US

IV. Provider business mailing address

PO BOX 22958
CLEVELAND OH
44122-0958
US

V. Phone/Fax

Practice location:
  • Phone: 440-449-5782
  • Fax: 440-449-7311
Mailing address:
  • Phone: 216-595-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number36003304H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: