Provider Demographics
NPI:1346685781
Name:IMAM, IMAM MOHAMMED (MD)
Entity Type:Individual
Prefix:
First Name:IMAM
Middle Name:MOHAMMED
Last Name:IMAM
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 1:990 E RIVER RD
Mailing Address - Street 2:APT # 108
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5669
Mailing Address - Country:US
Mailing Address - Phone:312-927-0357
Mailing Address - Fax:
Practice Address - Street 1:990 E RIVER RD
Practice Address - Street 2:APT # 108
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-5669
Practice Address - Country:US
Practice Address - Phone:312-927-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR72801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine