Provider Demographics
NPI:1669543740
Name:INGRAHAM, RAYMOND G (CFNP)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:G
Last Name:INGRAHAM
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-7806
Mailing Address - Fax:269-341-8743
Practice Address - Street 1:680 COLUMBIA AVE W
Practice Address - Street 2:BRONSON URGENT CARE
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3028
Practice Address - Country:US
Practice Address - Phone:269-965-4500
Practice Address - Fax:269-965-1150
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704122272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1669543740Medicaid
MI500C912770OtherBCBSM
MI1669543740Medicaid