Basic Information
| Provider Information | |||||||||
| NPI: | 1730173212 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IMAM | ||||||||
| FirstName: | AQIL | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 N EL CIELO RD | ||||||||
| Address2: | |||||||||
| City: | PALM SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922626972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603204122 | ||||||||
| FaxNumber: | 7607701608 | ||||||||
| Practice Location | |||||||||
| Address1: | 69844 HIGHWAY 111 | ||||||||
| Address2: | |||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922702849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603184869 | ||||||||
| FaxNumber: | 7607701608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 10/23/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | A46645 | CA | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
No ID Information.