Individual
DAVID A HIRSTIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1707 N 12TH ST, QUINCY, IL 62301
(217) 222-8641
(217) 222-8578
Mailing address
1707 N 12TH ST, BLDG 29M, QUINCY, IL 62301
(217) 222-9487
(217) 222-8578
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036112783
IL
208D00000X
General Practice Physician
036112783
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00211188
RAIL ROAD MEDICARE
—
Enumeration date
12/18/2006
Last updated
12/07/2009
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