Provider Demographics
NPI:1457631475
Name:A & E INTEGRATED HEALTH, S.C.
Entity Type:Organization
Organization Name:A & E INTEGRATED HEALTH, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZZONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-886-9500
Mailing Address - Street 1:656 N INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-1374
Mailing Address - Country:US
Mailing Address - Phone:815-886-9500
Mailing Address - Fax:815-886-9800
Practice Address - Street 1:656 N INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446-1374
Practice Address - Country:US
Practice Address - Phone:815-886-9500
Practice Address - Fax:815-886-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124389208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty