Provider Demographics
NPI:1427438415
Name:INGRAM, MICHAEL THOMAS JR (MS, MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:INGRAM
Suffix:JR
Gender:M
Credentials:MS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8271 MELROSE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6800
Mailing Address - Country:US
Mailing Address - Phone:949-436-9099
Mailing Address - Fax:475-313-1260
Practice Address - Street 1:8271 MELROSE AVE STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-6800
Practice Address - Country:US
Practice Address - Phone:213-545-1901
Practice Address - Fax:475-313-1260
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1453632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry