MEDICARE: DR. TRACY E. IRWIN 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	207V00000X	Obstetrics & Gynecology Physician	MD60471089	WA
2	207V00000X	Obstetrics & Gynecology Physician	036113414	IL

General Provider Information

NPI Number	:	1295786994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACY E. IRWIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 50095
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98145-5095
Country	:	US
Telephone Number	:	206-543-6420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 W SUPERIOR ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-5646
Country	:	US
Telephone Number	:	312-666-3494
Fax Number	:

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/09/2021

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