Provider Demographics
NPI:1922397298
Name:CONNECTICUT PULMONARY SPECIALISTS, PC
Entity Type:Organization
Organization Name:CONNECTICUT PULMONARY SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IMEVBORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-786-5067
Mailing Address - Street 1:PO BOX 8478
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06530-0478
Mailing Address - Country:US
Mailing Address - Phone:203-786-5067
Mailing Address - Fax:203-786-5162
Practice Address - Street 1:46 PRINCE ST
Practice Address - Street 2:SUITE 306
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1600
Practice Address - Country:US
Practice Address - Phone:203-786-5067
Practice Address - Fax:203-786-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty