MEDICARE: DR. THOMAS MARCUS MICK MD

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	207RS0010X	Sports Medicine (Internal Medicine) Physician	60 238722	NY
2	207R00000X	Internal Medicine Physician	60 238722	NY
3	2084P0800X	Psychiatry Physician	60 238722	NY
4	207RS0010X	Sports Medicine (Internal Medicine) Physician	35.137477	OH

General Provider Information

NPI Number	:	1639266679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS MARCUS MICK MD

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0002
Country	:	US
Telephone Number	:	216-444-5807
Fax Number	:	216-587-8646

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0002
Country	:	US
Telephone Number	:	216-444-5807
Fax Number	:	216-587-8646

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	01/08/2020

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