MEDICARE: DR. IRENE M HAMRICK 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
1	207Q00000X	Family Medicine Physician	56172	WI
2	207QG0300X	Geriatric Medicine (Family Medicine) Physician	35135982	OH

General Provider Information

NPI Number	:	1801888623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRENE M HAMRICK MD

Provider Business Mailing Address
First Line	:	5633 KINSALE DR
Second Line	:
City	:	FITCHBURG
State	:	WI
Zip	:	53711-6929
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5633 KINSALE DR
Second Line	:
City	:	FITCHBURG
State	:	WI
Zip	:	53711-6929
Country	:	US
Telephone Number	:	608-241-9020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	03/31/2020

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