Provider Demographics
NPI:1720515554
Name:IMIC INC
Entity Type:Organization
Organization Name:IMIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKOLOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-310-7477
Mailing Address - Street 1:18320 FRANJO RD
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5503
Mailing Address - Country:US
Mailing Address - Phone:786-310-7477
Mailing Address - Fax:305-252-2199
Practice Address - Street 1:18320 FRANJO RD
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5503
Practice Address - Country:US
Practice Address - Phone:786-310-7477
Practice Address - Fax:305-252-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment