Individual
BRUCE WILLIAM IRWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 HOLLISTER DR, SUITE 206, LIBERTYVILLE, IL 60048-5263
(847) 549-1609
(847) 549-1646
Mailing address
1800 HOLLISTER DR, SUITE 206, LIBERTYVILLE, IL 60048-5263
(847) 549-1609
(847) 549-1646
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
036086240
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360862401
—
IL
01
—
04920125
BC/BS OF IL
IL
Enumeration date
04/05/2006
Last updated
01/05/2010
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