Provider Demographics
NPI:1902239452
Name:IRVINE, CURTIS DETLOR (MD)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:DETLOR
Last Name:IRVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6057 FOUNTAIN POINTE
Mailing Address - Street 2:APT 9
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5331
Mailing Address - Country:US
Mailing Address - Phone:810-394-8709
Mailing Address - Fax:
Practice Address - Street 1:6057 FOUNTAIN POINTE
Practice Address - Street 2:APT 9
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7738
Practice Address - Country:US
Practice Address - Phone:810-394-8709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine