Provider Demographics
NPI:1538175047
Name:LIFRAK, IRWIN LANCE (MD)
Entity type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:LANCE
Last Name:LIFRAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 N UNION ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2731
Mailing Address - Country:US
Mailing Address - Phone:302-654-7317
Mailing Address - Fax:302-654-3042
Practice Address - Street 1:1010 N UNION ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2731
Practice Address - Country:US
Practice Address - Phone:302-654-7317
Practice Address - Fax:302-654-3042
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000548301Medicaid
DE4209096OtherAETNA
DEB66614Medicare UPIN
DE434192Medicare ID - Type Unspecified