Individual
ALEXANDER IGOLNIKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
901 LINCOLNWAY, SUITE 306, LA PORTE, IN 46350-3430
(219) 324-0875
(219) 324-0827
Mailing address
PO BOX 1690, LA PORTE, IN 46352-1690
(219) 326-2312
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01071639A
IN
207RG0100X
Gastroenterology Physician
36108351
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000782162
ANTHEM BCBS
IN
05
—
036108351
—
IL
01
—
151020007
MEDICARE PTAN
IN
05
—
201096920
—
IN
Enumeration date
10/13/2006
Last updated
03/07/2023
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