Provider Demographics
NPI:1255866976
Name:INTEGRATIVE MEDICAL CARE PC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHIOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-460-6733
Mailing Address - Street 1:1749 S NAPERVILLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5892
Mailing Address - Country:US
Mailing Address - Phone:630-460-6733
Mailing Address - Fax:630-752-1222
Practice Address - Street 1:1749 S NAPERVILLE RD STE 205
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5892
Practice Address - Country:US
Practice Address - Phone:630-460-6733
Practice Address - Fax:630-752-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty