Provider Demographics
NPI:1285701649
Name:MANN, IRWIN (DPM)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:
Last Name:MANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NUTTAL BRANCH
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-6367
Mailing Address - Country:US
Mailing Address - Phone:248-628-0189
Mailing Address - Fax:
Practice Address - Street 1:375 NUTTAL BRANCH
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371-6367
Practice Address - Country:US
Practice Address - Phone:248-628-0189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000733213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1675617Medicaid
MI1675617Medicaid
5635025Medicare PIN