Provider Demographics
NPI:1922135136
Name:MCCORMACK, MICHAEL PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:MCCORMACK
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 1:1330 MERCY DR NW
Mailing Address - Street 2:SUITE 522
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2626
Mailing Address - Country:US
Mailing Address - Phone:330-588-4856
Mailing Address - Fax:330-588-4857
Practice Address - Street 1:1330 MERCY DR NW
Practice Address - Street 2:SUITE 522
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2626
Practice Address - Country:US
Practice Address - Phone:330-588-4856
Practice Address - Fax:330-588-4857
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009124208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2955128Medicaid
OHP00935266OtherRAILROAD MEDICARE
OH4293911Medicare PIN