Individual
RONI AIZIGOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA, NP-C
Contact information
Practice address
51050 BITTERSWEET RD STE B, GRANGER, IN 46530-7879
(718) 208-0446
(574) 244-0240
Mailing address
50653 HOLLYBROOK DR, GRANGER, IN 46530-4947
(718) 208-0446
(574) 244-0240
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71011097A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28206614A
IN
Other
Enumeration date
10/23/2012
Last updated
10/06/2022
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