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NPI Code Detail

MEDICARE: DR. KIMBERLY COUTURE IRELAND M.D.

MEDICARE: DR. KIMBERLY COUTURE IRELAND M.D.
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
1207W00000XOphthalmology Physician42556WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17075205OTHERWIAETNA
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
38808855OTHERWICIGNA
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366435851
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIMBERLY COUTURE IRELAND M.D.
Provider Business Mailing Address
First Line : 1050 OLD CAMP RD
Second Line : BUILDING # 230
City : THE VILLAGES
State : FL
Zip : 32162-1762
Country : US
Telephone Number : 352-350-8484
Fax Number : 352-751-9850
Provider Business Practice Location Address
First Line : 36500 AURORA DR
Second Line :
City : SUMMIT
State : WI
Zip : 53066-4899
Country : US
Telephone Number : 262-434-5000
Fax Number : 262-434-5000
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 03/26/2013

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