Provider Demographics
NPI:1891997433
Name:IGELMAN, JON MARK (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MARK
Last Name:IGELMAN
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 1:3113 DEVON DRIVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-9750
Mailing Address - Country:US
Mailing Address - Phone:765-935-6319
Mailing Address - Fax:765-935-6319
Practice Address - Street 1:3113 DEVON DRIVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-9750
Practice Address - Country:US
Practice Address - Phone:765-935-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01018789207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology