Provider Demographics
NPI:1235318304
Name:INTEGRATIVE PEDIATRICS, PC
Entity Type:Organization
Organization Name:INTEGRATIVE PEDIATRICS, PC
Other - Org Name:RICHARD L LINSK, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:LINSK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-786-3833
Mailing Address - Street 1:1310 S MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3725
Mailing Address - Country:US
Mailing Address - Phone:734-786-3833
Mailing Address - Fax:734-994-8622
Practice Address - Street 1:1310 S MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3725
Practice Address - Country:US
Practice Address - Phone:734-786-3833
Practice Address - Fax:734-994-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063144208000000X
MI5101016620208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356355580Medicaid
MIG97181Medicare UPIN