Provider Demographics
NPI:1164749701
Name:IMPROVOLA, JOSE GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:GABRIEL
Last Name:IMPROVOLA
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 1:2325 18TH ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5388
Mailing Address - Country:US
Mailing Address - Phone:812-379-2020
Mailing Address - Fax:
Practice Address - Street 1:2325 18TH ST
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5388
Practice Address - Country:US
Practice Address - Phone:812-379-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138633207RC0000X
VA0101268367207RC0000X
IN01073737A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000990788OtherANTHEM PIN
OH2565399Medicaid
IN201229440Medicaid