| Doctor Name: | DR. MICHAEL ERIC IVORY |
| NPI Number: | 1952521874 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | 5101007170 |
| Business Practice Address: | 516 E. Nizhoni Blvd. Gallup, NM - 873011337 |
| Business Phone Number: | 5057221000 |
| Business Fax Number: | 5057268740 |
| Mailing Address: | 4070 N Chipman St, OWOSSO |
| State: | MI |
| Postal Code: | 488679444 |
| Phone Number: | 9897235236 |
| Fax Number: | |
| NPI Enumeration Date: | 04/26/2007 |
| NPI Last Update Date: | 09/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101007170 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |