Provider Demographics
NPI:1295174860
Name:SHLIFER, IGOR GARY (DO)
Entity type:Individual
Prefix:
First Name:IGOR
Middle Name:GARY
Last Name:SHLIFER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20301 VENTURA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-0934
Mailing Address - Country:US
Mailing Address - Phone:818-346-4300
Mailing Address - Fax:818-346-4301
Practice Address - Street 1:20301 VENTURA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0934
Practice Address - Country:US
Practice Address - Phone:818-346-4300
Practice Address - Fax:818-346-4301
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine