Provider Demographics
NPI:1578826996
Name:MICHAEL HIRT MD PC
Entity type:Organization
Organization Name:MICHAEL HIRT MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-345-2828
Mailing Address - Street 1:5620 WILBUR AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1351
Mailing Address - Country:US
Mailing Address - Phone:818-345-2828
Mailing Address - Fax:818-345-2848
Practice Address - Street 1:5620 WILBUR AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1351
Practice Address - Country:US
Practice Address - Phone:818-345-2828
Practice Address - Fax:818-345-2848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL HIRT MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-20
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639279292OtherNPI
CAG46735Medicare UPIN
CA1639279292OtherNPI