Provider Demographics
NPI:1932493236
Name:INTEGRATIVE MEDICAL OPTIONS LLC
Entity Type:Organization
Organization Name:INTEGRATIVE MEDICAL OPTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LACAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-695-6262
Mailing Address - Street 1:305 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1844
Mailing Address - Country:US
Mailing Address - Phone:847-695-6262
Mailing Address - Fax:847-695-6348
Practice Address - Street 1:305 N. 2ND ST
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:847-695-6262
Practice Address - Fax:847-695-6348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065641207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty