Provider Demographics
NPI:1659827467
Name:INTEGRATIVE GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GYNECOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-418-2188
Mailing Address - Street 1:1200 BARRISTER ROAD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2820
Mailing Address - Country:US
Mailing Address - Phone:734-418-2188
Mailing Address - Fax:
Practice Address - Street 1:2345 S HURON PKWY
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-5124
Practice Address - Country:US
Practice Address - Phone:734-418-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty