Provider Demographics
NPI:1346309796
Name:JOHN TKACH MD
Entity Type:Organization
Organization Name:JOHN TKACH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TKACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-454-3501
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-0116
Mailing Address - Country:US
Mailing Address - Phone:207-454-3500
Mailing Address - Fax:207-454-3503
Practice Address - Street 1:5 LOWELL ST
Practice Address - Street 2:SUITE 6
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1712
Practice Address - Country:US
Practice Address - Phone:207-454-3500
Practice Address - Fax:207-454-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty