Provider Demographics
NPI:1154828689
Name:INGRAM, CODY R (DPM, MPH)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:R
Last Name:INGRAM
Suffix:
Gender:M
Credentials:DPM, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42925 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-2277
Mailing Address - Country:US
Mailing Address - Phone:248-349-3900
Mailing Address - Fax:
Practice Address - Street 1:42925 7 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-2277
Practice Address - Country:US
Practice Address - Phone:248-349-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400352213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery