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General NPI Number Information
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NPI Number | 1174876577
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Entity Type | Individual
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Provider Name | RONI AIZIGOV CRNA, NP-C
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Gender | Male
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 51050 BITTERSWEET RD STE B
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City | GRANGER
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State | IN
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Zip | 46530-7879
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Country | US
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Telephone | 718-208-0446
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Fax | 574-244-0240
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Provider Business Mailing Address
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Address Line | 50653 HOLLYBROOK DR
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City | GRANGER
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State | IN
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Zip | 46530-4947
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Country | US
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Telephone | 718-208-0446
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Fax | 574-244-0240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71011097A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 28206614A
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License Number State | IN
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