Provider Demographics
NPI:1760446074
Name:IRWIN, MICHAEL DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DENNIS
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-284-4517
Mailing Address - Fax:
Practice Address - Street 1:6216 E SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-9105
Practice Address - Country:US
Practice Address - Phone:813-397-5300
Practice Address - Fax:813-738-9006
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117702207QA0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015444200Medicaid
NC24363OtherPARTNERS MEDICARE
NC73272OtherMEDCOST
NC8945446Medicaid
NC45422OtherBCBS NC
C84671Medicare UPIN
NC7595062OtherAETNA