Basic Information
| Provider Information | |||||||||
| NPI: | 1194783829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABOLNIK | ||||||||
| FirstName: | IGOR | ||||||||
| MiddleName: | Z | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 N 500 W | ||||||||
| Address2: | |||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013742367 | ||||||||
| FaxNumber: | 8014298015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1055 N 500 W | ||||||||
| Address2: | SUITE 202 BLDG C | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013742367 | ||||||||
| FaxNumber: | 8014298015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 3106671205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 870281028000 | 05 | UT | MEDICAID | 92-00030 | 01 | UT | UNITED HEALTHCARE | OTHER | QM0000035196 | 01 | UT | ALTIUS | OTHER | 55244 | 01 | UT | PEHP | OTHER | 589314 | 01 | UT | DMBA | OTHER | 107007723101 | 01 | UT | IHC HEALTHPLANS | OTHER | 440002649 | 01 | UT | PALMETTO GBA | OTHER |