Provider Demographics
NPI:1457337602
Name:PROKOPIW, IGOR (MD)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:PROKOPIW
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 1:9 HEALTHCARE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9449
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:9 HEALTHCARE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9449
Practice Address - Country:US
Practice Address - Phone:207-283-1427
Practice Address - Fax:207-283-1429
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME016107207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1643593OtherAETNA
ME305071OtherHARVARD PILGRIM HEALTHCAR
ME099888OtherANTHEM
ME255930099Medicaid
ME7898906OtherCIGNA
ME305071OtherHARVARD PILGRIM HEALTHCAR
MEMM999401Medicare PIN
MEH86756Medicare UPIN