Individual
DOMINIC CHARLES IMBURGIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 N MAPLE ST, EFFINGHAM, IL 62401-6401
(217) 347-2900
(217) 347-2922
Mailing address
901 N MAPLE ST, EFFINGHAM, IL 62401-6401
(217) 347-2900
(217) 347-2922
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03664959
—
IL
01
—
03800063
BCBS
IL
01
—
238531
HEALTHLINK
IL
01
—
40058
HEALTH ALLIANCE
IL
Enumeration date
06/29/2006
Last updated
07/08/2007
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