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NPI Code Detail

MEDICARE: DR. MICHELLE C MARCINCUK MD

MEDICARE: DR. MICHELLE C MARCINCUK 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
1207Y00000XOtolaryngology PhysicianK5615TX

General Provider Information

NPI Number : 1821098815
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELLE C MARCINCUK MD
Provider Business Mailing Address
First Line : PO BOX 733784
Second Line :
City : DALLAS
State : TX
Zip : 75373-3784
Country : US
Telephone Number : 682-885-1855
Fax Number : 682-885-1396
Provider Business Practice Location Address
First Line : 1500 COOPER ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-2710
Country : US
Telephone Number : 682-885-6850
Fax Number : 682-885-6799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2005
Last Update Date : 06/29/2023

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