Provider Demographics
NPI:1750381190
Name:IMANUEL, HOWARD M (DPM)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:M
Last Name:IMANUEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13681 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4318
Mailing Address - Country:US
Mailing Address - Phone:239-768-2323
Mailing Address - Fax:239-768-5530
Practice Address - Street 1:8851 BOARDROOM CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4888
Practice Address - Country:US
Practice Address - Phone:239-689-8910
Practice Address - Fax:239-433-8999
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO000705213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041327500Medicaid
T84638Medicare UPIN
FL041327500Medicaid