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NPI Code Detail

MEDICARE: JOHARI IMARA SUMMERVILLE

MEDICARE: JOHARI IMARA SUMMERVILLE
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1699624783
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHARI IMARA SUMMERVILLE
Provider Business Mailing Address
First Line : 4203 ASCOTT LN
Second Line :
City : WALLED LAKE
State : MI
Zip : 48390-1366
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1 GUSTAVE L LEVY PL
Second Line :
City : NEW YORK
State : NY
Zip : 10029-6504
Country : US
Telephone Number : 212-241-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2026
Last Update Date : 01/22/2026

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Directions to “ JOHARI IMARA SUMMERVILLE ” Practice Location

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