Provider Demographics
NPI:1306891783
Name:TINGELSTAD, KAARE E (DO)
Entity type:Individual
Prefix:
First Name:KAARE
Middle Name:E
Last Name:TINGELSTAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:541-523-8111
Mailing Address - Fax:541-523-1738
Practice Address - Street 1:3325 POCAHONTAS
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814
Practice Address - Country:US
Practice Address - Phone:541-523-8111
Practice Address - Fax:541-523-1738
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO24126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
118949Medicare ID - Type Unspecified
OR227327Medicaid
H87285Medicare UPIN