Provider Demographics
NPI:1528397056
Name:INTEGRATIVE SURGERY
Entity Type:Organization
Organization Name:INTEGRATIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MESSERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-522-9968
Mailing Address - Street 1:PO BOX 403506
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-1506
Mailing Address - Country:US
Mailing Address - Phone:786-522-9968
Mailing Address - Fax:305-571-7838
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:786-522-9968
Practice Address - Fax:305-571-7838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93472208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273556300Medicaid
FL273556300Medicaid