Individual
DR. IGOR TUBIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1116 N 16TH ST STE A, LAFAYETTE, IN 47904-2119
(765) 448-8000
(765) 448-8807
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
01062501A
IN
207RC0000X
Cardiovascular Disease Physician
036-116130
IL
207RC0000X
Cardiovascular Disease Physician
036116130
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000644782
ANTHEM PROVIDER NUMBER
IN
01
—
0533210001
DMERC
—
05
—
200974060
—
IN
Enumeration date
07/10/2006
Last updated
02/26/2021
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