Provider Demographics
NPI:1588657894
Name:IRVIN, MICHELLE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
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 1:16040 PARK VALLEY DR
Mailing Address - Street 2:#222
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3578
Mailing Address - Country:US
Mailing Address - Phone:512-341-8001
Mailing Address - Fax:512-341-8011
Practice Address - Street 1:16040 PARK VALLEY DR
Practice Address - Street 2:#222
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3578
Practice Address - Country:US
Practice Address - Phone:512-341-8001
Practice Address - Fax:512-341-8011
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7068 TX207V00000X
NH10177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F48115Medicare UPIN
00003LMedicare ID - Type Unspecified