Provider Demographics
NPI:1174559256
Name:PHILLIP M SCHIRCK, MD PLLC
Entity type:Organization
Organization Name:PHILLIP M SCHIRCK, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SCHIRCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-964-8880
Mailing Address - Street 1:790 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2716
Mailing Address - Country:US
Mailing Address - Phone:585-385-9030
Mailing Address - Fax:585-385-9124
Practice Address - Street 1:432 CLARKSON HAMLIN TOWNLINE ROAD
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:NY
Practice Address - Zip Code:14464
Practice Address - Country:US
Practice Address - Phone:585-964-8880
Practice Address - Fax:585-964-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0038Medicare ID - Type Unspecified