Provider Demographics
NPI:1700271509
Name:IRVINE, RON (MASTER OF MANAGEMENT)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:IRVINE
Suffix:
Gender:M
Credentials:MASTER OF MANAGEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 EASTERN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4736
Mailing Address - Country:US
Mailing Address - Phone:616-299-6374
Mailing Address - Fax:616-974-6497
Practice Address - Street 1:315 EASTERN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4736
Practice Address - Country:US
Practice Address - Phone:616-299-6374
Practice Address - Fax:616-974-6497
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator