Provider Demographics
NPI:1205656261
Name:INTEGRATED MEDICINE FOR MENS HEALTH
Entity type:Organization
Organization Name:INTEGRATED MEDICINE FOR MENS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAT
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-424-1488
Mailing Address - Street 1:226 INDIAN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2796
Mailing Address - Country:US
Mailing Address - Phone:219-424-1488
Mailing Address - Fax:219-267-1704
Practice Address - Street 1:2838 45TH ST STE A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2905
Practice Address - Country:US
Practice Address - Phone:219-424-1488
Practice Address - Fax:219-267-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care