MEDICARE: DR. SHAHRYAR TORK 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	208200000X	Plastic Surgery Physician	TP734	KY
2	208200000X	Plastic Surgery Physician	35132372	OH
3	208200000X	Plastic Surgery Physician	53280	KY
4	208200000X	Plastic Surgery Physician	35.130656	OH

General Provider Information

NPI Number	:	1699063057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHRYAR TORK MD

Provider Business Mailing Address
First Line	:	8404 EUSTIS FARM LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-4214
Country	:	US
Telephone Number	:	917-868-7875
Fax Number	:

Provider Business Practice Location Address
First Line	:	7136 MIAMI AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45243-2617
Country	:	US
Telephone Number	:	513-513-0460
Fax Number	:

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

Provider Enumeration Date	:	07/19/2011
Last Update Date	:	08/11/2024

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Directions to “ DR. SHAHRYAR TORK MD” Practice Location

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