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General NPI Number Information
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NPI Number | 1114104502
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE OF SPRINGFIELD, LLC
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 09/19/2011
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Provider Practice Location Address
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Address Line | 1835 E HIGH ST
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City | SPRINGFIELD
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State | OH
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Zip | 45505-5210
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Country | US
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Telephone | 937-323-8804
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Fax | 888-922-5090
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Provider Business Mailing Address
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Address Line | 1835 E HIGH ST
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City | SPRINGFIELD
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State | OH
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Zip | 45505-5210
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Country | US
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Telephone | 937-323-8804
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Fax | 888-922-5090
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Authorized Official
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Title or Position | PRESIDENT
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Name | YOICHI CHARLEY IMAMURA
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Credential | MD
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Telephone | 939-323-8804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35070875
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License Number State | OH
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