Provider Demographics
NPI:1750434403
Name:INTEGRATIVE MEDICINE ASSOCIATES, PC
Entity type:Organization
Organization Name:INTEGRATIVE MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MILGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-422-2555
Mailing Address - Street 1:2850 6TH AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6315
Mailing Address - Country:US
Mailing Address - Phone:619-422-2555
Mailing Address - Fax:619-422-2223
Practice Address - Street 1:2850 6TH AVE STE 412
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6315
Practice Address - Country:US
Practice Address - Phone:619-422-2555
Practice Address - Fax:619-422-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35411207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27771Medicare UPIN
CA0A35411Medicare ID - Type Unspecified