Healthcare Provider Details

I. General information

NPI: 1073536207
Provider Name (Legal Business Name): HOWARD M IMANUEL DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13681 METROPOLIS AVE
FORT MYERS FL
33912-4318
US

IV. Provider business mailing address

13681 METROPOLIS AVE
FORT MYERS FL
33912-4318
US

V. Phone/Fax

Practice location:
  • Phone: 239-768-2323
  • Fax: 239-768-5530
Mailing address:
  • Phone: 239-768-2323
  • Fax: 239-768-5530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD M IMANUEL
Title or Position: PRESIDENT
Credential: DPM
Phone: 239-768-2323