Individual
CHARLES R IRELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
430 PENNSYLVANIA AVE STE 150, GLEN ELLYN, IL 60137-4464
(888) 693-6437
(630) 432-6667
Mailing address
PO BOX 713260, CHICAGO, IL 60677-1260
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-076070
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036076070
—
IL
01
—
L10947
INDIVIDUAL MEDICARE #
—
Enumeration date
07/17/2006
Last updated
08/08/2023
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