Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 01073533A | IN |
Y | 208000000X | Pediatrician | 46855 | KY |
NPI | 1003115403 |
---|---|
Provider Name | Meredith Kay Irwin |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40207-5167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2011 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201220600A | (05) | IN |
7100214600 | (05) | KY |