Provider Demographics
NPI:1548317803
Name:IRICK, MAX L (MD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:L
Last Name:IRICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:SUITE 1234
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1417
Practice Address - Country:US
Practice Address - Phone:502-456-3990
Practice Address - Fax:502-456-3998
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY17516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201014360Medicaid
KY2537920OtherCIGNA- NMCA
KY50031968OtherPASSPORT- NMCA
KY000000692773OtherANTHEM- NCMA
KY64175169Medicaid
KYP00869556OtherRAILROAD MEDICARE- NCMA
KYP400024265Medicare PIN
KYP00869556OtherRAILROAD MEDICARE- NCMA