Basic Information
| Provider Information | |||||||||
| NPI: | 1861770398 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIGMATOULLINE | ||||||||
| FirstName: | DENIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2732 HILLVIEW CT | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162466360 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1805 27TH ST | ||||||||
| Address2: | E4902 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403568867 | ||||||||
| FaxNumber: | 7403566784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2011 | ||||||||
| LastUpdateDate: | 02/19/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35.125191 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.