Provider Demographics
NPI:1891296109
Name:IRELAN, LEVON DAVID
Entity Type:Individual
Prefix:
First Name:LEVON
Middle Name:DAVID
Last Name:IRELAN
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 1:2100 HEMMETER RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3944
Mailing Address - Country:US
Mailing Address - Phone:989-799-2100
Mailing Address - Fax:989-799-2637
Practice Address - Street 1:2100 HEMMETER RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3944
Practice Address - Country:US
Practice Address - Phone:989-799-2100
Practice Address - Fax:989-799-2637
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist