Basic Information
| Provider Information | |||||||||
| NPI: | 1033483011 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIRSCH MEDICAL AESTHETIC ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11623 ARBOR ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681442996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028847533 | ||||||||
| FaxNumber: | 4028840609 | ||||||||
| Practice Location | |||||||||
| Address1: | 11623 ARBOR ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681442996 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028847533 | ||||||||
| FaxNumber: | 4028840609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2012 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | KIRSCH | ||||||||
| AuthorizedOfficialFirstName: | DANNIEL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4028847533 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 21020 | NE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.