Provider Demographics
NPI:1730173212
Name:IMAM, AQIL P (MD)
Entity type:Individual
Prefix:DR
First Name:AQIL
Middle Name:P
Last Name:IMAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:275 N EL CIELO RD
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6972
Mailing Address - Country:US
Mailing Address - Phone:760-320-4122
Mailing Address - Fax:760-770-1608
Practice Address - Street 1:69844 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2849
Practice Address - Country:US
Practice Address - Phone:760-318-4869
Practice Address - Fax:760-770-1608
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA46645207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC57868Medicare UPIN
CA00A466450Medicare ID - Type Unspecified