Provider Demographics
NPI:1972643815
Name:IRWIN L. LIFRAK, M.D.
Entity Type:Organization
Organization Name:IRWIN L. LIFRAK, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIFRAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-654-7317
Mailing Address - Street 1:1010 N UNION ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2731
Mailing Address - Country:US
Mailing Address - Phone:302-654-7317
Mailing Address - Fax:302-654-3042
Practice Address - Street 1:1010 N UNION ST
Practice Address - Street 2:SUITE #5
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2731
Practice Address - Country:US
Practice Address - Phone:302-654-7317
Practice Address - Fax:302-654-3042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000548301Medicaid
DE0000548301Medicaid
DEB66614Medicare UPIN