MEDICARE: DR. DOUGLAS MICHAEL SIRKIN M.D.

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
1	207UN0903X	In Vivo & In Vitro Nuclear Medicine Physician	101861	NY
2	2085R0202X	Diagnostic Radiology Physician	101861	NY

General Provider Information

NPI Number	:	1588946503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS MICHAEL SIRKIN M.D.

Provider Business Mailing Address
First Line	:	259 TROY DEL WAY
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-3306
Country	:	US
Telephone Number	:	716-864-4087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 SHERIDAN DR
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-9405
Country	:	US
Telephone Number	:	716-836-8700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/15/2011

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