Healthcare Provider Details

I. General information

NPI: 1700947710
Provider Name (Legal Business Name): COLIN IRISH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SANDPOINT RD
MUNISING MI
49862-1406
US

IV. Provider business mailing address

1500 SANDPOINT RD
MUNISING MI
49862-1406
US

V. Phone/Fax

Practice location:
  • Phone: 906-387-4338
  • Fax: 906-387-2825
Mailing address:
  • Phone: 906-387-4338
  • Fax: 906-387-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101014041
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: