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General NPI Number Information
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NPI Number | 1346309796
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Entity Type | Organization
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Legal Business Name | JOHN TKACH MD
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 5 LOWELL ST SUITE 6
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City | CALAIS
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State | ME
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Zip | 04619-1712
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Country | US
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Telephone | 207-454-3500
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Fax | 207-454-3503
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Provider Business Mailing Address
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Address Line | PO BOX 116
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City | CALAIS
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State | ME
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Zip | 04619-0116
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Country | US
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Telephone | 207-454-3500
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Fax | 207-454-3503
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Authorized Official
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Title or Position | OWNER AND PROVIDER
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Name | JOHN TKACH
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Credential | MD
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Telephone | 207-454-3501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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