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NPI Code Detail

MEDICARE: DR. JEFFREY EATON ILSLEY MD

MEDICARE: DR. JEFFREY EATON ILSLEY MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician23938SC
2207Q00000XFamily Medicine PhysicianLL3916SC
3207P00000XEmergency Medicine Physician65669WI

General Provider Information

NPI Number : 1194703991
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY EATON ILSLEY MD
Provider Business Mailing Address
First Line : 200 1ST ST SW
Second Line :
City : ROCHESTER
State : MN
Zip : 55905-0002
Country : US
Telephone Number : 715-838-5222
Fax Number :
Provider Business Practice Location Address
First Line : 2321 STOUT RD
Second Line :
City : MENOMONIE
State : WI
Zip : 54751-7003
Country : US
Telephone Number : 715-235-5531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 09/03/2021

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