Provider Demographics
NPI:1134285042
Name:FERDKOFF, INGA (RSA)
Entity Type:Individual
Prefix:
First Name:INGA
Middle Name:
Last Name:FERDKOFF
Suffix:
Gender:F
Credentials:RSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2869
Mailing Address - Country:US
Mailing Address - Phone:630-322-9451
Mailing Address - Fax:630-322-9791
Practice Address - Street 1:4333 MAIN ST
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2869
Practice Address - Country:US
Practice Address - Phone:630-322-9451
Practice Address - Fax:630-322-9791
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist