Healthcare Provider Details

I. General information

NPI: 1750381190
Provider Name (Legal Business Name): HOWARD M IMANUEL DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 BOARDROOM CIR
FORT MYERS FL
33919-4888
US

IV. Provider business mailing address

13681 METROPOLIS AVE
FORT MYERS FL
33912-4318
US

V. Phone/Fax

Practice location:
  • Phone: 239-689-8910
  • Fax: 239-433-8999
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 NumberPO000705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: