Provider Demographics
NPI:1407864325
Name:SHIRK, ANDREW M (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:SHIRK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71-0776
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0776
Mailing Address - Country:US
Mailing Address - Phone:419-228-1506
Mailing Address - Fax:419-228-3352
Practice Address - Street 1:730 W MARKET STREET
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801
Practice Address - Country:US
Practice Address - Phone:419-227-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007646S207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2429072Medicaid
OHP00077099OtherRAILROAD MEDICARE
OH000000304310OtherANTHEM
H93611Medicare UPIN
OH2429072Medicaid