MEDICARE: MICHAEL D IRWIN PA

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	332B00000X	Durable Medical Equipment & Medical Supplies	2808	AL

General Provider Information

NPI Number	:	1568752574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL D IRWIN PA

Provider Business Mailing Address
First Line	:	4162 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3606
Country	:	US
Telephone Number	:	334-279-6910
Fax Number	:	334-279-6983

Provider Business Practice Location Address
First Line	:	4162 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3606
Country	:	US
Telephone Number	:	334-279-6910
Fax Number	:	334-279-6983

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	DR. MICHAEL D IRWIN
Credential	:	D.M.D.
Telephone Number	:	334-279-6910

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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