Provider Demographics
NPI:1396209409
Name:INTEGRATED MEDICAL & WELLNESS GROUP PLLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL & WELLNESS GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-433-6977
Mailing Address - Street 1:1315 ST JOSEPH PKWY STE 1010
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8235
Mailing Address - Country:US
Mailing Address - Phone:248-433-6977
Mailing Address - Fax:
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1010
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8235
Practice Address - Country:US
Practice Address - Phone:248-433-6977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty