Basic Information
| Provider Information | |||||||||
| NPI: | 1295990950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRSCH | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3212 SW 89TH ST. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053783300 | ||||||||
| FaxNumber: | 4053783993 | ||||||||
| Practice Location | |||||||||
| Address1: | 3212 SW 89TH ST. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053783300 | ||||||||
| FaxNumber: | 4053783993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2008 | ||||||||
| LastUpdateDate: | 08/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4655 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.