MEDICARE: ROSTISLAV IGNATOV, M.D., P.A.

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
1	2084P0804X	Child & Adolescent Psychiatry Physician	ME 93056	FL

General Provider Information

NPI Number	:	1609067131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSTISLAV IGNATOV, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 547265
Second Line	:
City	:	SURFSIDE
State	:	FL
Zip	:	33154-7265
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 S FEDERAL HWY
Second Line	:	STE. 102
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-6000
Country	:	US
Telephone Number	:	305-924-6593
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROSTISLAV IGNATOV
Credential	:	M.D.
Telephone Number	:	305-924-6593

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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