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NPI Code Detail

MEDICARE: DR. LARRY DAVID IREY PH.D.

MEDICARE: DR. LARRY DAVID IREY PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist6301003081MI

General Provider Information

NPI Number : 1497899868
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY DAVID IREY PH.D.
Provider Business Mailing Address
First Line : 139 COUNTRY CLUB BLVD
Second Line :
City : PLAINWELL
State : MI
Zip : 49080-9120
Country : US
Telephone Number : 269-207-7371
Fax Number :
Provider Business Practice Location Address
First Line : 4328 W MICHIGAN AVE
Second Line :
City : KALAMAZOO
State : MI
Zip : 49006-5823
Country : US
Telephone Number : 269-353-4223
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2007
Last Update Date : 07/08/2007

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