Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038.012507 | IL |
N | 111NN1001X | Nutrition | 038.012507 | IL |
NPI | 1588013775 |
---|---|
Provider Name | Dr. Matthew Jacob Imber |
First Address | Naperville, IL 60540-8138 |
Second Address | Naperville, IL 60540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 01/10/2019 |