Provider Demographics
NPI:1821098815
Name:MARCINCUK, MICHELLE C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:C
Last Name:MARCINCUK
Suffix:
Gender:F
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-6850
Practice Address - Fax:682-885-6799
Is Sole Proprietor?:No
Enumeration Date:2005-07-31
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5615207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159265102Medicaid
TXP00475702OtherRAIL ROAD MEDICARE
TX159265103OtherMEDICAID CSHCN
TXP00475702OtherRAIL ROAD MEDICARE
TX159265102Medicaid