Provider Demographics
NPI:1477687739
Name:IRELAND, IVAN ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:ANDREW
Last Name:IRELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19050 BAYTHORN WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-3810
Mailing Address - Country:US
Mailing Address - Phone:414-405-7167
Mailing Address - Fax:
Practice Address - Street 1:18110 W BLUEMOUND RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-2917
Practice Address - Country:US
Practice Address - Phone:262-860-1771
Practice Address - Fax:262-860-1781
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42239-020207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology