Provider Demographics
NPI:1801155023
Name:INGOLFSLAND, ELLEN COLEY (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:COLEY
Last Name:INGOLFSLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:COLEY
Other - Last Name:CHRISTIANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:EAST BUILDING, ROOM M136, DELIVERY CODE 8950
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-624-4418
Mailing Address - Fax:612-626-7042
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:EAST BUILDING, ROOM M136, DELIVERY CODE 8950
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-624-4418
Practice Address - Fax:612-626-7042
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN59102208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics