Individual
JACQUELINE M IRLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2311 N PROSPECT AVE, MILWAUKEE, WI 53211-4445
(414) 319-3000
(414) 319-3033
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 319-3000
(414) 319-3033
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
31057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31571200
—
WI
05
—
32813500
—
WI
Enumeration date
04/19/2006
Last updated
06/12/2012
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