Individual
DR. MICHAEL ERIC IVORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
516 E. NIZHONI BLVD., GALLUP, NM 87301-1337
(505) 722-1000
(505) 726-8740
Mailing address
4070 N CHIPMAN ST, OWOSSO, MI 48867-9444
(989) 723-5236
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
5101007170
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30010400
—
WI
05
—
4709700
—
MI
Enumeration date
04/26/2007
Last updated
09/27/2012
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