Provider Demographics
NPI:1700056710
Name:MICHELLE A IRVIN MD PA
Entity Type:Organization
Organization Name:MICHELLE A IRVIN MD PA
Other - Org Name:MICHELLE A IRVIN MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:EL
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-341-8001
Mailing Address - Street 1:2410 ROUND ROCK AVE
Mailing Address - Street 2:200
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4003
Mailing Address - Country:US
Mailing Address - Phone:512-341-8001
Mailing Address - Fax:512-341-8011
Practice Address - Street 1:2410 ROUND ROCK AVE
Practice Address - Street 2:200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4003
Practice Address - Country:US
Practice Address - Phone:512-341-8001
Practice Address - Fax:512-341-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7068207V00000X
NH10177207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0030CQOtherBCBS
F48115Medicare UPIN
00003LMedicare PIN