Healthcare Provider Details

I. General information

NPI: 1538116728
Provider Name (Legal Business Name): IM HEALTHCARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 BUSINESS WAY STE 2
LEHIGH ACRES FL
33936-6073
US

IV. Provider business mailing address

1220 BUSINESS WAY STE 2
LEHIGH ACRES FL
33936-6073
US

V. Phone/Fax

Practice location:
  • Phone: 239-303-2600
  • Fax: 239-303-2604
Mailing address:
  • Phone: 239-303-2600
  • Fax: 239-303-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS 7648
License Number StateFL

VIII. Authorized Official

Name: MR. JAMES B. MARTIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 239-303-2600