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NPI Code Detail

MEDICARE: DR. ROSTISLAV IGNATOV M.D.

MEDICARE: DR. ROSTISLAV IGNATOV M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084A0401XAddiction Medicine (Psychiatry & Neurology) PhysicianME93056FL
22084P0804XChild & Adolescent Psychiatry PhysicianME93056FL
32084P0800XPsychiatry PhysicianME93056FL

General Provider Information

NPI Number : 1497788103
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROSTISLAV IGNATOV M.D.
Provider Business Mailing Address
First Line : PO BOX 2261
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33402-2261
Country : US
Telephone Number : 305-924-6593
Fax Number :
Provider Business Practice Location Address
First Line : 1325 N HAVERHILL RD
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33417-5914
Country : US
Telephone Number : 305-924-6593
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2006
Last Update Date : 08/26/2024

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