Provider Demographics
NPI:1619433885
Name:IRELAN, MICHEAL
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:
Last Name:IRELAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHEAL
Other - Middle Name:EUGENE
Other - Last Name:DOXEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9040 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:JOINT BASE LEWIS MCCHORD
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1000
Mailing Address - Country:US
Mailing Address - Phone:253-968-5509
Mailing Address - Fax:235-968-0770
Practice Address - Street 1:VILSECK ARMY HEALTH CLINIC
Practice Address - Street 2:
Practice Address - City:VILSECK GERMANY
Practice Address - State:NY
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:314-590-3847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE32737207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine