MEDICARE: WITOLD IGLIKOWSKI MD PROF CORP

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	207R00000X	Internal Medicine Physician	NV20141070263	NV

General Provider Information

NPI Number	:	1730553504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WITOLD IGLIKOWSKI MD PROF CORP

Provider Business Mailing Address
First Line	:	217 CHESTNUT RIDGE CIR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-2162
Country	:	US
Telephone Number	:	702-630-0895
Fax Number	:	702-459-0864

Provider Business Practice Location Address
First Line	:	3753 HOWARD HUGHES PKWY # 200-216
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-0938
Country	:	US
Telephone Number	:	702-544-0179
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WITOLD IGLIKOWSKI
Credential	:	M.D.
Telephone Number	:	702-268-3079

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	09/30/2019

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