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NPI Code Detail

MEDICARE: KEVIN PAUL INGRAM

MEDICARE: KEVIN PAUL INGRAM
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1396341418
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN PAUL INGRAM
Provider Business Mailing Address
First Line : 1065 MEDINA RD STE 300
Second Line :
City : MEDINA
State : OH
Zip : 44256-5374
Country : US
Telephone Number : 330-596-1042
Fax Number : 614-515-5779
Provider Business Practice Location Address
First Line : 1065 MEDINA RD
Second Line :
City : MEDINA
State : OH
Zip : 44256-5375
Country : US
Telephone Number : 330-596-1042
Fax Number : 614-515-5779
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2020
Last Update Date : 02/18/2021

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Directions to “ KEVIN PAUL INGRAM ” Practice Location

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