Provider Demographics
NPI:1487607495
Name:ABOLS-MANTYH, INGRID (MD)
Entity type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:ABOLS-MANTYH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:
Other - Last Name:ABOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:501 E NICOLLET BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6772
Mailing Address - Country:US
Mailing Address - Phone:952-435-8516
Mailing Address - Fax:763-302-4336
Practice Address - Street 1:675 E NICOLLET BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6749
Practice Address - Country:US
Practice Address - Phone:952-435-8516
Practice Address - Fax:763-302-4336
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN290232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN100274C029OtherUCARE
WI31534800Medicaid
MNHP12761OtherHEALTHPARTNERS
MN130004283OtherRAILROAD MEDICARE
MN19364ABOtherBCBS OF MN
MN22665OtherAMERICA'S PPO
MN9040978000Medicaid
MN0265035OtherPREFERRED ONE
MN0517222OtherMEDICA
MNA85668Medicare UPIN
WI31534800Medicaid