Provider Demographics
NPI:1437137775
Name:IRVIN, AMY J (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:IRVIN
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 1:657 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2354
Mailing Address - Country:US
Mailing Address - Phone:651-681-7925
Mailing Address - Fax:
Practice Address - Street 1:657 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-2354
Practice Address - Country:US
Practice Address - Phone:651-681-7925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46009207P00000X
TXM7292207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN422926600Medicaid
TX8S5979OtherBCBS
TX187585801Medicaid
MN422926600Medicaid
TX187585801Medicaid
TX8J9504Medicare PIN
H87509Medicare UPIN