MEDICARE: DR. AQIL P IMAM MD

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	207K00000X	Allergy & Immunology Physician	A46645	CA

General Provider Information

NPI Number	:	1730173212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AQIL P IMAM MD

Provider Business Mailing Address
First Line	:	275 N EL CIELO RD
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6972
Country	:	US
Telephone Number	:	760-320-4122
Fax Number	:	760-770-1608

Provider Business Practice Location Address
First Line	:	69844 HIGHWAY 111
Second Line	:
City	:	RANCHO MIRAGE
State	:	CA
Zip	:	92270-2849
Country	:	US
Telephone Number	:	760-318-4869
Fax Number	:	760-770-1608

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	10/23/2013

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