Provider Demographics
NPI:1124068770
Name:INGENITO, ALLAN PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:PHILLIP
Last Name:INGENITO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3833 COON RAPIDS BLVD NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2697
Mailing Address - Country:US
Mailing Address - Phone:763-427-8320
Mailing Address - Fax:763-302-4338
Practice Address - Street 1:3833 COON RAPIDS BLVD NW
Practice Address - Street 2:SUITE 100
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2697
Practice Address - Country:US
Practice Address - Phone:763-427-8320
Practice Address - Fax:763-302-4338
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2019-03-19
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Provider Licenses
StateLicense IDTaxonomies
MN295842084N0402X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07691INOtherBCBS OF MN
MN130005768OtherRAILROAD MEDICARE
MN162078900Medicaid
WI30709400OtherWI MEDICAID
MN0265011OtherPREFERRED ONE
MNHP13588OtherHEALTHPARTNERS
MN0509674OtherMEDICA
MN100289C029OtherUCARE
MN22676OtherAMERICA'S PPO
MN0509674OtherMEDICA
MN100289C029OtherUCARE