Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PO2415 | FL |
NPI | 1497052658 |
---|---|
Provider Name | Dr. Ibn A Imani |
First Address | Tallahassee, FL 32301-7737 |
Second Address | Tallahassee, FL 32308-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2011 |
Last Update Date | 07/01/2013 |