1730173212 NPI number — DR. AQIL P IMAM MD

Table of content: DR. AQIL P IMAM MD (NPI 1730173212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730173212 NPI number — DR. AQIL P IMAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IMAM
Provider First Name:
AQIL
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730173212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
275 N EL CIELO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-6972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-320-4122
Provider Business Mailing Address Fax Number:
760-770-1608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69844 HIGHWAY 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-318-4869
Provider Business Practice Location Address Fax Number:
760-770-1608
Provider Enumeration Date:
09/09/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  A46645 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)