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General NPI Number Information
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NPI Number | 1215939848
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Entity Type | Individual
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Provider Name | JOHN P IMM MD
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Gender | Male
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Dates
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Enumeration Date | 08/12/2005
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 5700 MONROE ST UNIT 111
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City | SYLVANIA
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State | OH
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Zip | 43560-2779
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Country | US
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Telephone | 567-585-0005
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Fax | 567-585-0007
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Provider Business Mailing Address
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Address Line | 410 BIRCHARD AVE
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City | FREMONT
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State | OH
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Zip | 43420-2967
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Country | US
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Telephone | 419-334-8943
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Fax | 419-334-8619
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35064477
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License Number State | OH
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