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General NPI Number Information
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NPI Number | 1881375657
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Entity Type | Individual
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Provider Name | TOM AARON INGRAM
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Gender | Male
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 1653 W CONGRESS PKWY # 12
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City | CHICAGO
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State | IL
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Zip | 60612-3833
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Country | US
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Telephone | 706-580-0650
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Fax |
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Provider Business Mailing Address
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Address Line | 221 W HUBBARD ST UNIT 1708
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City | CHICAGO
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State | IL
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Zip | 60654-4920
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Country | US
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Telephone | 706-580-0650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 1-174846
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209030865
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License Number State | IL
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