Provider Demographics
NPI:1194783829
Name:ABOLNIK, IGOR Z (MD)
Entity type:Individual
Prefix:
First Name:IGOR
Middle Name:Z
Last Name:ABOLNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-374-2367
Mailing Address - Fax:801-429-8015
Practice Address - Street 1:2280 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:RUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3305
Practice Address - Country:US
Practice Address - Phone:707-443-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3106671205207RI0200X
CAC145403207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT589314OtherDMBA
UT870281028000Medicaid
UT55244OtherPEHP
UT107007723101OtherIHC HEALTHPLANS
UT440002649OtherPALMETTO GBA
UTQM0000035196OtherALTIUS
UT92-00030OtherUNITED HEALTHCARE
UTG84158Medicare UPIN
UT92-00030OtherUNITED HEALTHCARE