Provider Demographics
NPI:1043479025
Name:IRFAN R IMAMI MD PL
Entity Type:Organization
Organization Name:IRFAN R IMAMI MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRFAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:IMAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-473-1066
Mailing Address - Street 1:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-0819
Mailing Address - Country:US
Mailing Address - Phone:321-473-1066
Mailing Address - Fax:321-733-0211
Practice Address - Street 1:1140 BROADBAND DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2623
Practice Address - Country:US
Practice Address - Phone:321-473-1066
Practice Address - Fax:321-733-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty