=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447286307
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILLIP MICHAEL SCHIRCK MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 11/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 432 HAMLIN CLARKSON TOWNLINE RD
-----------------------------------------------------
City | HAMLIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-964-8880
-----------------------------------------------------
Fax | 585-964-8886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 790 LINDEN AVE
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14625-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-385-9030
-----------------------------------------------------
Fax | 585-385-9124
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 177181
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------