Provider Demographics
NPI:1114988383
Name:TARGOWSKI, IRMINA (MD)
Entity Type:Individual
Prefix:
First Name:IRMINA
Middle Name:
Last Name:TARGOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-6114
Mailing Address - Country:US
Mailing Address - Phone:269-375-0400
Mailing Address - Fax:269-372-8484
Practice Address - Street 1:6565 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-6114
Practice Address - Country:US
Practice Address - Phone:269-375-0400
Practice Address - Fax:269-372-8484
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1733022Medicaid
MIOC96050004004Medicare ID - Type Unspecified
MIA78075Medicare UPIN