Provider Demographics
NPI:1336712579
Name:FLEMMING, IRVING P
Entity type:Individual
Prefix:
First Name:IRVING
Middle Name:P
Last Name:FLEMMING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14202 LAKESIDE BVLD N.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315
Mailing Address - Country:US
Mailing Address - Phone:586-488-1256
Mailing Address - Fax:
Practice Address - Street 1:14202 LAKESIDE BVLD N.
Practice Address - Street 2:SUITE 100
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315
Practice Address - Country:US
Practice Address - Phone:586-488-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No133N00000XDietary & Nutritional Service ProvidersNutritionist