Healthcare Provider Details

I. General information

NPI: 1285640896
Provider Name (Legal Business Name): IGOR SINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 SPRINGHURST BLVD SUITE 104
LOUISVILLE KY
40241-6137
US

IV. Provider business mailing address

3801 SPRINGHURST BLVD SUITE 104
LOUISVILLE KY
40241-6137
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-5614
  • Fax: 502-425-5633
Mailing address:
  • Phone: 502-425-5614
  • Fax: 502-425-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25392
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number036109211
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: