Organization
THEODORE S. INGRASSIA, III, M.D.S.C.
Active
Organization
THEODORE S. INGRASSIA, III, M.D.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE S. INGRASSIA III M.D. (PRESIDENT)
(815) 397-7212
Entity
Organization
Contact information
Practice address
5668 E STATE ST, SUITE B600, ROCKFORD, IL 61108-2490
(815) 397-7212
(815) 397-2539
Mailing address
5668 E STATE ST, SUITE B600, ROCKFORD, IL 61108-2490
(815) 397-7212
(815) 397-2539
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101 00686
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/18/2006
Last updated
03/11/2008
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