Provider Demographics
NPI:1568786630
Name:IDREES, IRUM MONA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRUM
Middle Name:MONA
Last Name:IDREES
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:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-605-3721
Mailing Address - Fax:864-512-4595
Practice Address - Street 1:135 COMMONWEALTH DR STE 170
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6940
Practice Address - Country:US
Practice Address - Phone:864-297-0080
Practice Address - Fax:864-297-4588
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36219207RR0500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC362191Medicaid
SCP01417209OtherRR MEDICARE
SC362191Medicaid