Healthcare Provider Details

I. General information

NPI: 1750353884
Provider Name (Legal Business Name): INGRID SHARON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: INGRID MEDNIS

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 N UNION BLVD SUITE 370
COLORADO SPRINGS CO
80907-4900
US

IV. Provider business mailing address

3920 N UNION BLVD SUITE 370
COLORADO SPRINGS CO
80907-4900
US

V. Phone/Fax

Practice location:
  • Phone: 719-477-0211
  • Fax: 719-477-0501
Mailing address:
  • Phone: 719-477-0211
  • Fax: 719-477-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number34226
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: