This paper explores the establishment and first decades of the Tıphane ve Cerrahhane-i Amire (Imperial School of Medicine & the Imperial School of Surgery, later called the Mekteb-i Tıbbiye-i Şahane or Imperial School of Medicine, among other names), in Istanbul. It delves into the schools pre-history, in particular Mustafa Behçet Efendi's involvement in two short-lived medical educational projects in Istanbul prior to his success with the Tıphane-i Amire in 1827, first with a school for Ottoman Rum (Greek Orthodox Christian) students and the second a naval medical academy for Ottoman Muslims. He spearheaded the establishment of this medical school with the support of Sultan Mahmud II, under whom he also served as hekimbaşı, or head doctor. This paper then examines the ways in which this school, in terms of its goals, curricula, faculty, and students, differed from the existing Süleymaniye Medical School in Istanbul, and delves into the significance of those differences. In particular, it looks into the identities and inter-communal dynamics of the faculty and students and the explicit focus on military medicine in its founding years, in contrast to the subsequent split into separate military and civilian medical schools. It examines on the varied interests of the founding faculties and their connections to other causes and regions -for example, faculty members at the Ottoman Imperial School of Medicine like Stephanos and Constantinos Caratheodory, and Sarantis Archigenis, were engaged with Hellenism and education reform for Greek Orthodox Christians specifically in addition to their ties to Ottoman imperial medical education and the Ottoman state. Many of the early faculty, administrators, and students of these schools also had attended the same foreign institutions abroad in medical hubs like Paris, Berlin, Padua, and Vienna, and incorporated those experiences into their conceptions on how to found their respective new institutions. I argue that this school, as the first in the empire to educate Muslim and non-Muslim students together, holds a unique place in Ottoman educational history. Delving more deeply into its early decades with this in mind, as well gesturing to the ways in which its establishment and activities did and did not disrupt the constitution of the medical profession in the Ottoman empire, which one could argue had been dominated by Italian-trained, non-Muslim physicians in prior centuries, yields new fruit.