Provider Demographics
NPI:1467575241
Name:IRELAND, JOHN CALVIN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CALVIN
Last Name:IRELAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SE BLUE PKWY
Mailing Address - Street 2:SUITE 270 B
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-1041
Mailing Address - Country:US
Mailing Address - Phone:816-333-1919
Mailing Address - Fax:816-333-2614
Practice Address - Street 1:2000 SE BLUE PKWY
Practice Address - Street 2:SUITE 270 B
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-1041
Practice Address - Country:US
Practice Address - Phone:816-333-1919
Practice Address - Fax:816-333-2614
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004024406207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200613650AMedicaid
MO1467575241Medicaid
KS200613650BMedicaid
MO1467575241Medicaid
MOW19000175Medicare PIN
KS200613650BMedicaid
KS200613650AMedicaid
MOP00688349Medicare PIN