Basic Information
| Provider Information | |||||||||
| NPI: | 1568787265 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INGHAM REGIONAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 E GRANT ST APT 808 | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554041441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6129916770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 W GREENLAWN AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489102819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179757888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 04/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | ESTHARABADI | ||||||||
| AuthorizedOfficialFirstName: | NAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | INTERNAL MEDICINE RESIDENT (PGY1) | ||||||||
| AuthorizedOfficialTelephone: | 6129916770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.