MEDICARE: INGRAM CO

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	80451165	OH

General Provider Information

NPI Number	:	1275880619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INGRAM CO

Provider Business Mailing Address
First Line	:	600 SUPERIOR AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2614
Country	:	US
Telephone Number	:	401-374-9350
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 SUPERIOR AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2614
Country	:	US
Telephone Number	:	401-374-9350
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PAUL BUCARAT
Credential	:
Telephone Number	:	401-374-9350

Provider Enumeration Date	:	08/03/2012
Last Update Date	:	09/18/2012

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Directions to “INGRAM CO ” Practice Location

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