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Individual

ALISA D INGRAM

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
501 VAN BUREN ST, SUITE 203, FOSTORIA, OH 44830-1593
(419) 436-1035
(419) 435-0849
Mailing address
501 VAN BUREN ST, SUITE 203, FOSTORIA, OH 44830-1593
(419) 436-1035
(419) 435-0849

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35082217
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000348462
ANTHEM
OH
01
04357
PARAMOUNT
OH
01
23-54980
UHC
OH
05
2408933
OH
01
7871493
AETNA
OH
01
P00061267
RRMC
OH
Enumeration date
07/27/2005
Last updated
07/08/2007
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