Provider Demographics
NPI:1922030592
Name:SHIRCK, THOMAS M (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:SHIRCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4925 BRADENTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7532
Mailing Address - Country:US
Mailing Address - Phone:614-336-7666
Mailing Address - Fax:614-336-7682
Practice Address - Street 1:4925 BRADENTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7532
Practice Address - Country:US
Practice Address - Phone:614-336-7666
Practice Address - Fax:614-336-7682
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34002905207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0489350Medicaid
OH0512422Medicare ID - Type UnspecifiedPROVIDER
OH0489350Medicaid