Provider Demographics
NPI:1144345703
Name:SIRKIN, JONATHAN W (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:W
Last Name:SIRKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24200 CHAGRIN BLVD
Mailing Address - Street 2:THE OFFICE PLACE
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5550
Mailing Address - Country:US
Mailing Address - Phone:216-283-7690
Mailing Address - Fax:216-766-6084
Practice Address - Street 1:24200 CHAGRIN BLVD
Practice Address - Street 2:THE OFFICE PLACE
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5550
Practice Address - Country:US
Practice Address - Phone:216-283-7690
Practice Address - Fax:216-766-6084
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350815232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150170Medicaid
H67417Medicare UPIN
OH0150170Medicaid