Provider Demographics
NPI:1952911315
Name:INGHAM HEALTHCARE A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:INGHAM HEALTHCARE A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:INGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-227-6947
Mailing Address - Street 1:1821 S BASCOM AVE STE 383
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2309
Mailing Address - Country:US
Mailing Address - Phone:650-722-2611
Mailing Address - Fax:
Practice Address - Street 1:1999 S BASCOM AVE STE 1020
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2206
Practice Address - Country:US
Practice Address - Phone:650-722-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty