Healthcare Provider Details

I. General information

NPI: 1003115403
Provider Name (Legal Business Name): MEREDITH KAY IRWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MALLARD CREEK RD STE 395
LOUISVILLE KY
40207-5167
US

IV. Provider business mailing address

PO BOX 77651
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-9421
  • Fax: 502-899-5762
Mailing address:
  • Phone: 502-272-5754
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01073533A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46855
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: