Provider Demographics
NPI:1891244810
Name:MCGURK, CHRISTOPHER BENNETT
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:BENNETT
Last Name:MCGURK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 HOMEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-1217
Mailing Address - Country:US
Mailing Address - Phone:330-907-4315
Mailing Address - Fax:
Practice Address - Street 1:464 ZAHN DR APT 3
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5556
Practice Address - Country:US
Practice Address - Phone:330-329-5815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0168567305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH910000561905Medicaid