Individual
IGOR VIKTOROVICH AKSENOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4700 WATERS AVE STE 507, SAVANNAH, GA 31404-6220
(912) 350-4750
(912) 350-4751
Mailing address
4700 WATERS AVE STE 507, SAVANNAH, GA 31404-6220
(912) 350-4750
(912) 350-4751
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
062644
GA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
062644
GA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
ME94813
FL
207RP1001X
Pulmonary Disease Physician
Primary
062644
GA
207RP1001X
Pulmonary Disease Physician
ME94813
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01286490
AMERIGROUP
—
05
—
321479371A
—
GA
05
—
321479371B
—
GA
01
—
518768
WELLCARE
GA
05
—
G62644
—
SC
01
—
P00733491
RAILROAD MEDICARE
GA
Enumeration date
11/03/2006
Last updated
01/25/2022
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