Individual
MARIO J IMOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3600 S LOGAN ST, SUITE 100, ENGLEWOOD, CO 80113-3766
(303) 839-7980
(303) 839-7936
Mailing address
3600 S LOGAN ST, SUITE 100, ENGLEWOOD, CO 80113-3766
(303) 839-7980
(303) 839-7936
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
38335
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117142900
—
WY
01
—
841553144
TAX ID
CO
05
—
95739831
—
CO
Enumeration date
08/15/2005
Last updated
10/17/2011
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