Provider Demographics
NPI:1740378447
Name:ESTRINE, IRWIN H (DO)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:H
Last Name:ESTRINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 BLOOMFIELD SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3304
Mailing Address - Country:US
Mailing Address - Phone:586-754-2030
Mailing Address - Fax:
Practice Address - Street 1:3412 BLOOMFIELD SHORE DR
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-3304
Practice Address - Country:US
Practice Address - Phone:586-754-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005681207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1716157Medicaid
0N89980Medicare ID - Type Unspecified
E30918Medicare UPIN