Provider Demographics
NPI:1821639253
Name:MEINHOFER, IRA S
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:S
Last Name:MEINHOFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 W RACE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-5481
Mailing Address - Country:US
Mailing Address - Phone:916-724-9450
Mailing Address - Fax:
Practice Address - Street 1:2231 W RACE AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-5481
Practice Address - Country:US
Practice Address - Phone:916-724-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician