Individual ProviderMichiaki ImamuraThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic PhysiciansPractice Address6621 Fannin Street, Wt-19345h, Houston, TX 77030-2399(832) 826-1929PECOS EnrollmentBased on the most recent information from CMS, provider Michiaki Imamura is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1215028402Provider TypeIndividualFull NameImamura, MichiakiTitleDr.CredentialMD, PHDGenderMaleSole ProprietorNoEnumeration Date9/27/2006Last Updated3/23/2018Contact InformationPractice LocationPractice Address6621 Fannin Street, Wt-19345h, Houston, TX 77030-2399Phone(832) 826-1929Fax(832) 825-1904Mailing LocationMailing Address6621 Fannin Street, Wt-19345h, Houston, TX 77030-2399Phone(832) 826-1929Fax(832) 825-1904Provider TaxonomiesCodeDescriptionLicenseCode208G00000XPrimaryDescriptionThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic PhysiciansLicense45912TexasCode208600000XDescriptionSurgeryAllopathic & Osteopathic PhysiciansLicenseE-3474ArkansasCode208G00000XDescriptionThoracic Surgery (Cardiothoracic Vascular Surgery)Allopathic & Osteopathic PhysiciansLicenseE-3474ArkansasProvider IdentifiersIDDescriptionIssuerID148197001DescriptionMedicaidIssuerUnlistedArkansasID02100031400DescriptionOtherIssuerQUALCHOICEArkansas