Provider Demographics
NPI:1194915710
Name:GIRSCHEK, BRENDAN P (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:P
Last Name:GIRSCHEK
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 1:4800 N 22ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4963
Mailing Address - Country:US
Mailing Address - Phone:602-955-1000
Mailing Address - Fax:602-231-6215
Practice Address - Street 1:350 N SWITZER CANYON DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4826
Practice Address - Country:US
Practice Address - Phone:928-779-0500
Practice Address - Fax:602-508-4830
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ67737207WX0107X, 207W00000X
IAMD-39182207WX0107X
IA39182207W00000X
TN44844207W00000X
FLME140484207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3041625OtherMEDICARE PTAN
IA1194915710Medicaid
IA719270026OtherMEDICARE PTAN
AZ145884Medicaid