Provider Demographics
NPI:1912201310
Name:NATIONAL CENTER FOR INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:NATIONAL CENTER FOR INTEGRATIVE MEDICINE
Other - Org Name:NCIM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAO
Authorized Official - Middle Name:
Authorized Official - Last Name:KILARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-330-3100
Mailing Address - Street 1:3100 THEODORE ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8534
Mailing Address - Country:US
Mailing Address - Phone:815-330-3100
Mailing Address - Fax:815-330-3115
Practice Address - Street 1:3100 THEODORE ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8534
Practice Address - Country:US
Practice Address - Phone:815-330-3100
Practice Address - Fax:815-330-3115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38.011832111N00000X
IL36.060189207P00000X
IL36.113633207Q00000X
IL85.003604363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty