Provider Demographics
NPI:1548856743
Name:INGRAM, KAM
Entity type:Individual
Prefix:
First Name:KAM
Middle Name:
Last Name:INGRAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 ROYAL PALM BEACH BLVD STE 400B
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1692
Mailing Address - Country:US
Mailing Address - Phone:561-792-9242
Mailing Address - Fax:
Practice Address - Street 1:1402 ROYAL PALM BEACH BLVD STE 400B
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1692
Practice Address - Country:US
Practice Address - Phone:561-792-9242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other