Provider Demographics
NPI:1366435851
Name:IRELAND, KIMBERLY COUTURE (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:COUTURE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1050 OLD CAMP RD
Mailing Address - Street 2:BUILDING # 230
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-1762
Mailing Address - Country:US
Mailing Address - Phone:352-350-8484
Mailing Address - Fax:352-751-9850
Practice Address - Street 1:36500 AURORA DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:WI
Practice Address - Zip Code:53066-4899
Practice Address - Country:US
Practice Address - Phone:262-434-5000
Practice Address - Fax:262-434-5000
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI42556207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7075205OtherAETNA
WI34017100Medicaid
WI8808855OtherCIGNA
WI8808855OtherCIGNA
WI002068570Medicare PIN
WI002302650Medicare PIN
WI410044057Medicare PIN