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General NPI Number Information
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NPI Number | 1518149467
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Entity Type | Individual
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Provider Name | IGOR SISTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 200 W ARBOR DR
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City | SAN DIEGO
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State | CA
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Zip | 92103-9000
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Country | US
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Telephone | 800-926-8273
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Fax |
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Provider Business Mailing Address
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Address Line | 911 NORTHLAND DR
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City | PRINCETON
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State | MN
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Zip | 55371-2172
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Country | US
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Telephone |
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Fax |
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 40933
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | C164561
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 32872
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 74296
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | C164561
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License Number State | CA
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Taxonomy #6
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 164561
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License Number State | CA
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