Provider Demographics
NPI:1083837306
Name:IMPERATO, MICHAEL FRANCIS
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:IMPERATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6457 E SNOWDON ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-9757
Mailing Address - Country:US
Mailing Address - Phone:480-219-1048
Mailing Address - Fax:
Practice Address - Street 1:51 W 3RD ST
Practice Address - Street 2:SUITE 501
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2831
Practice Address - Country:US
Practice Address - Phone:480-317-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046056L183500000X
AZ13460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist