MEDICARE: DR. ROSTISLAV IGNATOV M.D.

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	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	ME93056	FL
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME93056	FL
3	2084P0800X	Psychiatry Physician	ME93056	FL

General Provider Information

NPI Number	:	1497788103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSTISLAV IGNATOV M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2261
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33402-2261
Country	:	US
Telephone Number	:	305-924-6593
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 N HAVERHILL RD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-5914
Country	:	US
Telephone Number	:	305-924-6593
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/26/2024

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