Individual
THOMAS GLENN INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1111 CROWN POINTE DR, ELIZABETHTOWN, KY 42701-7101
(800) 545-9031
Mailing address
PO BOX 6209, ELIZABETHTOWN, KY 42702-6209
(888) 259-0031
(859) 757-4501
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28724
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64287246
—
KY
01
—
P00101625
RAILROAD MEDICARE
KY
Enumeration date
06/10/2005
Last updated
04/20/2020
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