Provider Demographics
NPI:1568752574
Name:MICHAEL D IRWIN PA
Entity Type:Organization
Organization Name:MICHAEL D IRWIN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-279-6910
Mailing Address - Street 1:4162 LOMAC ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-3606
Mailing Address - Country:US
Mailing Address - Phone:334-279-6910
Mailing Address - Fax:334-279-6983
Practice Address - Street 1:4162 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-3606
Practice Address - Country:US
Practice Address - Phone:334-279-6910
Practice Address - Fax:334-279-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2808332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies