Provider Demographics
NPI:1295111318
Name:IMPERIAL ENTERPRISE OF OHIO LLC
Entity type:Organization
Organization Name:IMPERIAL ENTERPRISE OF OHIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-554-3683
Mailing Address - Street 1:PO BOX 340765
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45434-0765
Mailing Address - Country:US
Mailing Address - Phone:618-554-3683
Mailing Address - Fax:
Practice Address - Street 1:245 W ELMWOOD DR STE 100
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4259
Practice Address - Country:US
Practice Address - Phone:618-554-3683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty