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General NPI Number Information
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NPI Number | 1437249182
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Entity Type | Individual
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Provider Name | ALEXANDER IGOLNIKOV MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 901 LINCOLNWAY SUITE 306
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City | LA PORTE
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State | IN
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Zip | 46350-3430
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Country | US
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Telephone | 219-324-0875
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Fax | 219-324-0827
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Provider Business Mailing Address
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Address Line | PO BOX 1690
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City | LA PORTE
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State | IN
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Zip | 46352-1690
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Country | US
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Telephone | 219-326-2312
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Fax | 219-326-2584
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 36108351
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 01071639A
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License Number State | IN
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