Provider Demographics
NPI:1821429309
Name:THOMAS SCHENK MD, PLLC
Entity Type:Organization
Organization Name:THOMAS SCHENK MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHENK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-471-6934
Mailing Address - Street 1:2900 W RAY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-7342
Mailing Address - Country:US
Mailing Address - Phone:480-471-6934
Mailing Address - Fax:480-471-6943
Practice Address - Street 1:2905 W WARNER RD
Practice Address - Street 2:SUITE 19
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1674
Practice Address - Country:US
Practice Address - Phone:602-318-9671
Practice Address - Fax:480-240-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG72752Medicare UPIN