Healthcare Provider Details

I. General information

NPI: 1750341509
Provider Name (Legal Business Name): RONALD BRIAN IRWIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 HARRINGTON ST SUITE 201
MT CLEMENS MI
48043
US

IV. Provider business mailing address

1000 HARRINGTON ST TED WAHBY CANCER CENTER SUITE 201
MOUNT CLEMENS MI
48043-2920
US

V. Phone/Fax

Practice location:
  • Phone: 586-493-7575
  • Fax: 586-493-7576
Mailing address:
  • Phone: 586-493-7575
  • Fax: 586-493-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301030763
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: