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General NPI Number Information
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NPI Number | 1245248061
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Entity Type | Organization
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Legal Business Name | INGHAM RADIOLOGY ASSOCIATES, PC
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2909 E GRAND RIVER AVE SUITE 102
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City | LANSING
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State | MI
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Zip | 48912-4300
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Country | US
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Telephone | 517-372-9256
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Fax |
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Provider Business Mailing Address
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Address Line | 780 W LAKE LANSING RD SUITE 800
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City | EAST LANSING
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State | MI
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Zip | 48823-8474
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Country | US
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Telephone | 517-372-9256
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK CIMMERER
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Credential | MD
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Telephone | 517-372-9256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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