Provider Demographics
NPI:1447270459
Name:INGEGNO, MICHAEL D (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:INGEGNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13851 E 14TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2631
Mailing Address - Country:US
Mailing Address - Phone:510-347-4700
Mailing Address - Fax:510-347-4712
Practice Address - Street 1:13851 E 14TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2631
Practice Address - Country:US
Practice Address - Phone:510-347-4700
Practice Address - Fax:510-347-4712
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG682022086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS315ZMedicare PIN
CA00G682021Medicare PIN
CACR0889Medicare PIN
CAZZZ15705ZMedicare PIN
CAZZZ94434ZMedicare PIN
CAZZZ29924ZMedicare PIN
CAZZZ99493ZMedicare PIN
CAF18556Medicare UPIN
CACS315YMedicare PIN
CACS315XMedicare PIN
CAZZZ99495ZMedicare PIN