Provider Demographics
NPI:1093170391
Name:INTEGRATIVE AND RESTORATIVE MEDICAL CENTER
Entity Type:Organization
Organization Name:INTEGRATIVE AND RESTORATIVE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MISHA
Authorized Official - Middle Name:JOSEF
Authorized Official - Last Name:PAYANT
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:941-979-6509
Mailing Address - Street 1:1720 EL JOBEAN RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1261
Mailing Address - Country:US
Mailing Address - Phone:941-979-6509
Mailing Address - Fax:
Practice Address - Street 1:1720 EL JOBEAN RD
Practice Address - Street 2:SUITE 108
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1261
Practice Address - Country:US
Practice Address - Phone:941-979-6509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3370171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty