Provider Demographics
NPI:1689769432
Name:TINGLE, MICHELE (DO)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:TINGLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 87TH LN
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-7312
Mailing Address - Country:US
Mailing Address - Phone:515-491-1802
Mailing Address - Fax:
Practice Address - Street 1:9128 87TH LN
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125
Practice Address - Country:US
Practice Address - Phone:515-491-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3052207P00000X
IA03052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1689769432Medicaid
IA9144444Medicaid
IAIB1436016Medicare PIN
IA9144444Medicaid
IAIB1436016Medicare PIN