Healthcare Provider Details

I. General information

NPI: 1619433885
Provider Name (Legal Business Name): MICHEAL IRELAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHEAL EUGENE DOXEY

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 05/08/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILSECK ARMY HEALTH CLINIC
VILSECK GERMANY NY
09112
US

IV. Provider business mailing address

9040 JACKSON AVE
JOINT BASE LEWIS MCCHORD WA
98431-1000
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-3847
  • Fax:
Mailing address:
  • Phone: 253-968-5509
  • Fax: 235-968-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32737
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: