Provider Demographics
NPI:1073536207
Name:HOWARD M IMANUEL DPM PA
Entity Type:Organization
Organization Name:HOWARD M IMANUEL DPM PA
Other - Org Name:THE PODIATRY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:IMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-768-2323
Mailing Address - Street 1:13681 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4318
Mailing Address - Country:US
Mailing Address - Phone:239-768-2323
Mailing Address - Fax:239-768-5530
Practice Address - Street 1:13681 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4318
Practice Address - Country:US
Practice Address - Phone:239-768-2323
Practice Address - Fax:239-768-5530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCB8440OtherRAILROAD MEDICARE
FLCB8440OtherRAILROAD MEDICARE