Provider Demographics
NPI:1821182023
Name:STINES, INGRID M (DPM, FACFAS)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:M
Last Name:STINES
Suffix:
Gender:F
Credentials:DPM, FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 PATIENT CARE WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4299
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:517-374-7659
Practice Address - Street 1:3955 PATIENT CARE WAY
Practice Address - Street 2:SUITE A
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4299
Practice Address - Country:US
Practice Address - Phone:517-374-7600
Practice Address - Fax:517-374-7659
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIIS001340213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1821182023Medicaid
MI1066979OtherMCLAREN
MI200000032680OtherPHP OF MID MICHIGAN
MI4061788OtherAETNA
MI4853312980OtherBLUE CROSS BLUE SHIELD/BLUE CARE NETWORK OF MICHIGAN
MI1821182023Medicaid
MI4853312980OtherBLUE CROSS BLUE SHIELD/BLUE CARE NETWORK OF MICHIGAN