MEDICARE: MICHAEL T 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	G42531	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	94-1688832	OTHER		TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G42531	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1699773788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T INGRAM MD

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:	800-470-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 L ST FL 6
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5616
Country	:	US
Telephone Number	:	916-887-4845
Fax Number	:	916-887-4075

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	10/31/2019

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Directions to “ MICHAEL T INGRAM MD” Practice Location

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