Provider Demographics
NPI:1942009683
Name:KONSTANTINOV, IGOR E (MD, PHD, FRACS)
Entity type:Individual
Prefix:PROF
First Name:IGOR
Middle Name:E
Last Name:KONSTANTINOV
Suffix:
Gender:M
Credentials:MD, PHD, FRACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BRISBANE STREET
Mailing Address - Street 2:
Mailing Address - City:ASCOT VALE
Mailing Address - State:VICTORIA
Mailing Address - Zip Code:VIC 3032
Mailing Address - Country:AU
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 BRISBANE STREET
Practice Address - Street 2:
Practice Address - City:ASCOT VALE
Practice Address - State:VICTORIA
Practice Address - Zip Code:VIC 3032
Practice Address - Country:AU
Practice Address - Phone:040-523-3226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME172640208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery