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NPI Code Detail

MEDICARE: MR. TRAVIS MICHAEL TIRK MMS, PA-C, ATC, M ED

MEDICARE: MR. TRAVIS MICHAEL TIRK MMS, PA-C, ATC, M ED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician Assistant5008AZ
2363A00000XPhysician Assistant5008AZ

General Provider Information

NPI Number : 1285852962
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TRAVIS MICHAEL TIRK MMS, PA-C, ATC, M ED
Provider Business Mailing Address
First Line : PO BOX 80217
Second Line :
City : PHOENIX
State : AZ
Zip : 85060-0217
Country : US
Telephone Number : 602-385-2115
Fax Number : 480-418-3323
Provider Business Practice Location Address
First Line : 1675 E MELROSE ST STE 101-103
Second Line :
City : GILBERT
State : AZ
Zip : 85297-1001
Country : US
Telephone Number : 602-648-5444
Fax Number : 602-772-3801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 07/29/2022

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Directions to “ MR. TRAVIS MICHAEL TIRK MMS, PA-C, ATC, M ED” Practice Location

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