Provider Demographics
NPI:1174034367
Name:INTEGRATIVE FAMILY MEDICINE OF CT, PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE FAMILY MEDICINE OF CT, PLLC
Other - Org Name:STAMFORD NATUROPATHIC & ACUPUNCTURE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:203-623-5796
Mailing Address - Street 1:1435 BEDFORD ST STE 1R
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5225
Mailing Address - Country:US
Mailing Address - Phone:203-832-6992
Mailing Address - Fax:203-658-8728
Practice Address - Street 1:1435 BEDFORD ST STE 1R
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5225
Practice Address - Country:US
Practice Address - Phone:203-832-6992
Practice Address - Fax:203-658-8728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000443175F00000X
CT52918204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty