Provider Demographics
NPI:1760646863
Name:IM MEDICAL, P.A.
Entity Type:Organization
Organization Name:IM MEDICAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:K
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-364-4840
Mailing Address - Street 1:6080 BOYNTON BEACH BLVD
Mailing Address - Street 2:STE. 220
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3588
Mailing Address - Country:US
Mailing Address - Phone:561-364-4840
Mailing Address - Fax:561-364-4068
Practice Address - Street 1:6080 BOYNTON BEACH BLVD
Practice Address - Street 2:STE. 220
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3588
Practice Address - Country:US
Practice Address - Phone:561-364-4840
Practice Address - Fax:561-364-4068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7106Medicare PIN