Basic Information
| Provider Information | |||||||||
| NPI: | 1760646863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IM MEDICAL, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6080 BOYNTON BEACH BLVD | ||||||||
| Address2: | STE. 220 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334373588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613644840 | ||||||||
| FaxNumber: | 5613644068 | ||||||||
| Practice Location | |||||||||
| Address1: | 6080 BOYNTON BEACH BLVD | ||||||||
| Address2: | STE. 220 | ||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334373588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613644840 | ||||||||
| FaxNumber: | 5613644068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2008 | ||||||||
| LastUpdateDate: | 07/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | THOMPSON | ||||||||
| AuthorizedOfficialFirstName: | ISAAC | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5613644840 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.