Provider Demographics
NPI:1548384100
Name:INTEGRATIVE MEDICINE CENTER
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OKONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-274-3413
Mailing Address - Street 1:9371 CYPRESS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4939
Mailing Address - Country:US
Mailing Address - Phone:239-274-3413
Mailing Address - Fax:239-415-8661
Practice Address - Street 1:9371 CYPRESS LAKE DR STE 13
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4995
Practice Address - Country:US
Practice Address - Phone:239-274-3413
Practice Address - Fax:239-415-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 36300146D00000X
FL001033 AP171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 36300OtherMEDICAL LICENSE
PINOtherD 79863
11490OtherBLUE CROSS
001033 APOtherACUPUNCTUE LICENSE
CO 434OtherBLUE CROSS
FLME 36300OtherMEDICAL LICENSE