Provider Demographics
NPI:1952365116
Name:IRELAND, CLIFF J (DO)
Entity type:Individual
Prefix:DR
First Name:CLIFF
Middle Name:J
Last Name:IRELAND
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Gender:M
Credentials:DO
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Mailing Address - Street 1:4905 OLD ORCHARD CTR
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1425
Mailing Address - Country:US
Mailing Address - Phone:847-679-6707
Mailing Address - Fax:847-679-6721
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1425
Practice Address - Country:US
Practice Address - Phone:847-679-6707
Practice Address - Fax:847-679-6721
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-05-20
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Provider Licenses
StateLicense IDTaxonomies
IL036071364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621317OtherBLUE CROSS BLUE SHIELD
IL490750Medicare PIN
ILD16570Medicare UPIN