Provider Demographics
NPI:1861666869
Name:KIRSCH, THERESE (MD)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:THERESE
Other - Middle Name:LYN
Other - Last Name:KIRSCH-KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9809 PEDDLERS WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1865
Mailing Address - Country:US
Mailing Address - Phone:407-342-1626
Mailing Address - Fax:
Practice Address - Street 1:820 S WOOD ST
Practice Address - Street 2:DEPT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-7033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036131504207V00000X
GA86683207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology