Provider Demographics
NPI:1952591638
Name:PARK, INGRID (MDCM)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:PARK
Suffix:
Gender:F
Credentials:MDCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 CORNELL RD
Mailing Address - Street 2:211
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3858
Mailing Address - Country:US
Mailing Address - Phone:216-394-7585
Mailing Address - Fax:
Practice Address - Street 1:1110 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1603
Practice Address - Country:US
Practice Address - Phone:216-844-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program