Provider Demographics
NPI:1235360140
Name:FORDE, INGA C (MD)
Entity Type:Individual
Prefix:
First Name:INGA
Middle Name:C
Last Name:FORDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-3048
Mailing Address - Fax:952-853-8727
Practice Address - Street 1:640 JACKSON ST # MS 11502B
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-3135
Practice Address - Fax:651-254-3135
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52215207R00000X, 207RC0200X, 207RP1001X
MN104440207RC0200X
WI66869207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX297630002Medicaid
TX297630001Medicaid
MNENROLLEDMedicaid
TX297630002Medicaid
TX297630001Medicaid
MN810000266Medicare PIN
MN810000222Medicare PIN