Provider Demographics
NPI:1881676864
Name:IMBER, MICHAEL J (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:IMBER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 N DIXIE HWY
Mailing Address - Street 2:STE 308
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2712
Mailing Address - Country:US
Mailing Address - Phone:561-653-8005
Mailing Address - Fax:561-653-8051
Practice Address - Street 1:1500 N DIXIE HWY
Practice Address - Street 2:STE 308
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2712
Practice Address - Country:US
Practice Address - Phone:561-653-8005
Practice Address - Fax:561-653-8051
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57284207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057827400Medicaid
FL14412ZMedicare PIN
A59322Medicare UPIN
FL057827400Medicaid