Provider Demographics
NPI:1962628016
Name:MIRSHAK, MONIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:
Last Name:MIRSHAK
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 1:167 MEANS HALL
Mailing Address - Street 2:1654 UPHAM DR.
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-293-3551
Mailing Address - Fax:614-293-3124
Practice Address - Street 1:167 MEANS HALL
Practice Address - Street 2:1654 UPHAM DR.
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-3551
Practice Address - Fax:614-293-3124
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant