Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10143 | MI |
Y | 213EG0000X | General Practice | 10143 | MI |
NPI | 1003887555 |
---|---|
Provider Name | Joseph M Irmen |
First Address | Midland, MI 48640-2310 |
Second Address | Midland, MI 48640-2310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2709818 | (05) | MI |