Provider Demographics
NPI:1366448235
Name:KIRSCHENBAUM, ROBERT TERRY (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TERRY
Last Name:KIRSCHENBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 N STATE ROAD 434
Mailing Address - Street 2:STE B
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7014
Mailing Address - Country:US
Mailing Address - Phone:407-869-7077
Mailing Address - Fax:321-777-8302
Practice Address - Street 1:840 N STATE ROAD 434
Practice Address - Street 2:STE B
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7014
Practice Address - Country:US
Practice Address - Phone:407-869-7077
Practice Address - Fax:321-777-8302
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO967213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041256200Medicaid
FL0955000001OtherMEDICARE DMERC 2ND LOCAL
FL1366448235OtherMEDICARE DMERC
FL041256200Medicaid
0955000001Medicare NSC
FL0955000001OtherMEDICARE DMERC 2ND LOCAL
87850Medicare PIN