Doctor Name: | MICHAEL IMBURGIA |
NPI Number: | 1023380276 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BA |
License Number: | |
Business Practice Address: | 3176 Lancer St Portage, IN - 463684408 |
Business Phone Number: | 2197629557 |
Business Fax Number: | |
Mailing Address: | 2963 Joann St, PORTAGE |
State: | IN |
Postal Code: | 463683927 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/03/2012 |
NPI Last Update Date: | 02/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |