Healthcare Provider Details

I. General information

NPI: 1235759960
Provider Name (Legal Business Name): JOHN PAUL IMPERIAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 SPRING ARBOR RD
JACKSON MI
49203-3794
US

IV. Provider business mailing address

3305 SPRING ARBOR RD
JACKSON MI
49203-3794
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-3187
  • Fax:
Mailing address:
  • Phone: 517-205-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301511492
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: