Individual
IVAN ZADOUNAEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3311
Mailing address
611 W PARK ST, URBANA, IL 61801-2529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036160448
IL
207Q00000X
Family Medicine Physician
19489
NH
207Q00000X
Family Medicine Physician
R-10727
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19489
NH LICENSE
NH
Enumeration date
06/28/2016
Last updated
12/02/2022
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