Provider Demographics
NPI:1124331343
Name:IAMARINO, PAUL A (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:IAMARINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:600 OAKMONT LN STE 600C
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:1485 N MICHIGAN AVE
Practice Address - Street 2:STE 100
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-3105
Practice Address - Country:US
Practice Address - Phone:517-545-5880
Practice Address - Fax:517-545-5887
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501010289225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211031Medicare PIN
MIN69750009Medicare PIN