Provider Demographics
NPI:1760458939
Name:IMLER, MICHAEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:IMLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1291 WINTER GARDEN VINELAND RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6705
Mailing Address - Country:US
Mailing Address - Phone:407-501-7100
Mailing Address - Fax:407-501-7200
Practice Address - Street 1:1291 WINTER GARDEN VINELAND RD STE 130
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6705
Practice Address - Country:US
Practice Address - Phone:407-501-7100
Practice Address - Fax:407-501-7200
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84970207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107453Medicaid
ILK05113Medicare PIN
IL036107453Medicaid