=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245472711
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN P HIRSH DPM PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2009
-----------------------------------------------------
Last Update Date | 02/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3332 GRIFFIN RD
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33312-5519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-924-6151
-----------------------------------------------------
Fax | 954-434-6463
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4611 S UNIVERSITY DR SUITE 225
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33328-3817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-434-6463
-----------------------------------------------------
Fax | 954-434-6463
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVEN P HIRSH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-434-6463
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | PO0001789
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------