Individual
JOHN MICHAEL IMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD., L.P.
Contact information
Practice address
300 3RD AVE SE, SUITE 405, ROCHESTER, MN 55904-4619
(507) 288-8544
(507) 288-8545
Mailing address
1357 WINDBREAK CT NE, ROCHESTER, MN 55906-8587
(507) 289-5409
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP2523
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143305
UCARE
MN
01
—
362J3IM
BCBS OF MN
MN
01
—
921001033636
PREFERRED ONE
MN
01
—
HP38677
HEALTHPARTNERS
MN
Enumeration date
02/27/2007
Last updated
07/09/2007
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