MEDICARE: JOSE GABRIEL IMPROVOLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	35.138633	OH
2	207RC0000X	Cardiovascular Disease Physician	0101268367	VA
3	207RC0000X	Cardiovascular Disease Physician	01073737A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000990788	OTHER	IN	ANTHEM PIN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164749701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE GABRIEL IMPROVOLA M.D.

Provider Business Mailing Address
First Line	:	2325 18TH ST
Second Line	:	SUITE 130
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5388
Country	:	US
Telephone Number	:	812-379-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 18TH ST
Second Line	:	SUITE 130
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5388
Country	:	US
Telephone Number	:	812-379-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2010
Last Update Date	:	04/13/2021

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Directions to “ JOSE GABRIEL IMPROVOLA M.D.” Practice Location

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