Individual
IRENE R MIRKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7780 ELMWOOD AVE, MIDDLETON, WI 53562-5407
(608) 417-3434
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-6000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29156
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1000324
PPIC PROVIDER #
—
05
—
31391800
—
WI
Enumeration date
06/12/2006
Last updated
12/14/2011
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