Provider Demographics
NPI:1245248061
Name:INGHAM RADIOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:INGHAM RADIOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CIMMERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-372-9256
Mailing Address - Street 1:780 W LAKE LANSING RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8474
Mailing Address - Country:US
Mailing Address - Phone:517-372-9256
Mailing Address - Fax:
Practice Address - Street 1:2909 E GRAND RIVER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4300
Practice Address - Country:US
Practice Address - Phone:517-372-9256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C37602OtherBLUE CROSS BLUE SHIELD
MICE9698OtherRAILROAD MEDICARE
MI1002896OtherMCLAREN HEALTH ADVANTAGE
MI1017356OtherMCLAREN HEALTH ADVANTAGE
MI9000251OtherHEALTHPLUS MI
MICK0098OtherRAILROAD MEDICARE
MI0C37603OtherBLUE CROSS BLUE SHIELD
MI00465OtherPRIORITY HEALTH
MI1002897OtherMCLAREN HEALTH ADVANTAGE
MI105014OtherPREFERRED CHOICES
MI0C37602OtherBLUE CROSS BLUE SHIELD
MI=========051OtherCOMMUNITY CHOICE MI
MI0C36003Medicare ID - Type Unspecified