MEDICARE: IRWIN R MAIER M.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
1	2085R0202X	Diagnostic Radiology Physician	A61466	CA

General Provider Information

NPI Number	:	1275538431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRWIN R MAIER M.D.

Provider Business Mailing Address
First Line	:	11995 SINGLETREE LN
Second Line	:	STE 500
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-5347
Country	:	US
Telephone Number	:	952-595-1301
Fax Number	:	612-294-4903

Provider Business Practice Location Address
First Line	:	21320 PENNELEME RD
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-7992
Country	:	US
Telephone Number	:	952-595-1100
Fax Number	:	612-294-4903

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	01/09/2017

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