Provider Demographics
NPI:1699986901
Name:INGRAHAM, ANGELA M (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W MIFFLIN ST UNIT 8060
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-6013
Mailing Address - Country:US
Mailing Address - Phone:513-833-5205
Mailing Address - Fax:
Practice Address - Street 1:333 W MIFFLIN ST UNIT 8060
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-6013
Practice Address - Country:US
Practice Address - Phone:513-833-5205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63369-20208600000X
WI633692086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery