Provider Demographics
NPI:1245219104
Name:SCHENK, THOMAS MARCUS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARCUS
Last Name:SCHENK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27371 VISTA AZUL
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-1818
Mailing Address - Country:US
Mailing Address - Phone:949-481-6855
Mailing Address - Fax:
Practice Address - Street 1:27371 VISTA AZUL
Practice Address - Street 2:
Practice Address - City:CAPISTRANO BEACH
Practice Address - State:CA
Practice Address - Zip Code:92624-1818
Practice Address - Country:US
Practice Address - Phone:949-481-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA33822Medicare UPIN