Provider Demographics
NPI:1730553504
Name:WITOLD IGLIKOWSKI MD PROF CORP
Entity type:Organization
Organization Name:WITOLD IGLIKOWSKI MD PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WITOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:IGLIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-268-3079
Mailing Address - Street 1:217 CHESTNUT RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2162
Mailing Address - Country:US
Mailing Address - Phone:702-630-0895
Mailing Address - Fax:702-459-0864
Practice Address - Street 1:3753 HOWARD HUGHES PKWY # 200-216
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-0938
Practice Address - Country:US
Practice Address - Phone:702-544-0179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141070263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF63846Medicare UPIN