MEDICARE: DR. TERRI L INGRAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0700X	Neuroradiology Physician	30853	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	008551	OTHER	CO	KAISER COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1215948062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRI L INGRAM MD

Provider Business Mailing Address
First Line	:	938 BANNOCK ST
Second Line	:	STE 300
City	:	DENVER
State	:	CO
Zip	:	80204-4028
Country	:	US
Telephone Number	:	303-914-8800
Fax Number	:	303-716-3777

Provider Business Practice Location Address
First Line	:	938 BANNOCK ST
Second Line	:	STE 300
City	:	DENVER
State	:	CO
Zip	:	80204-4028
Country	:	US
Telephone Number	:	303-914-8800
Fax Number	:	303-716-3777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	05/07/2021

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