Individual
IMIKOMOBONG EKOPIMO IBIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-4100
Mailing address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-4100
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
109444
GA
207P00000X
Emergency Medicine Physician
290390
MA
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
290390
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2018
Last updated
08/10/2026
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