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General NPI Number Information
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NPI Number | 1275880619
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Entity Type | Organization
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Legal Business Name | INGRAM CO
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 600 SUPERIOR AVE E
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City | CLEVELAND
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State | OH
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Zip | 44114-2614
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Country | US
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Telephone | 401-374-9350
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Fax |
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Provider Business Mailing Address
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Address Line | 600 SUPERIOR AVE E
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City | CLEVELAND
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State | OH
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Zip | 44114-2614
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Country | US
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Telephone | 401-374-9350
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PAUL BUCARAT
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Credential |
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Telephone | 401-374-9350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 80451165
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License Number State | OH
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