Provider Demographics
NPI:1447286307
Name:SCHIRCK, PHILLIP MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:SCHIRCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2716
Mailing Address - Country:US
Mailing Address - Phone:585-385-9030
Mailing Address - Fax:585-385-9124
Practice Address - Street 1:432 HAMLIN CLARKSON TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:NY
Practice Address - Zip Code:14464
Practice Address - Country:US
Practice Address - Phone:585-964-8880
Practice Address - Fax:585-964-8886
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPREFERRED CAREOther101271BJ
NY000914902004OtherCOMMUNITY BLUE
NY01678371Medicaid
NYP010177181OtherBLUE CHOICE
NYP030177181OtherBLUE SHIELD
NYPREFERRED CAREOther101271BJ
NYP030177181OtherBLUE SHIELD