Healthcare Provider Details

I. General information

NPI: 1962603175
Provider Name (Legal Business Name): DANIEL AARON HIRSELJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 NW PETTYGROVE ST SUITE #210
PORTLAND OR
97210-2659
US

IV. Provider business mailing address

32 NE GRAHAM ST
PORTLAND OR
97212-3001
US

V. Phone/Fax

Practice location:
  • Phone: 503-223-6223
  • Fax:
Mailing address:
  • Phone: 503-284-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number35-089730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: