Healthcare Provider Details

I. General information

NPI: 1427340769
Provider Name (Legal Business Name): MICHELLE OBRIG SHIRAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 06/07/2022
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST M312
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

575 LEXINGTON AVE
NEW YORK NY
10022-6102
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2941
  • Fax: 212-746-8713
Mailing address:
  • Phone: 212-746-2962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number302857
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberR4145
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number302857
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR4145
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: