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General NPI Number Information
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NPI Number | 1497052658
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Entity Type | Individual
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Provider Name | IBN A IMANI D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 1628 N PLAZA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-2300
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Country | US
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Telephone | 850-402-9042
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Fax |
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Provider Business Mailing Address
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Address Line | 216 W COLLEGE AVE #871
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City | TALLAHASSEE
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State | FL
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Zip | 32301-7737
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Country | US
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Telephone | 850-402-9042
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Fax |
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | PO2415
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License Number State | FL
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