Provider Demographics
NPI:1831517911
Name:INTEGRATIVE MEDICINE STRATEGIST
Entity type:Organization
Organization Name:INTEGRATIVE MEDICINE STRATEGIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEOFF
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAULA
Authorized Official - Suffix:
Authorized Official - Credentials:MAC
Authorized Official - Phone:508-686-5100
Mailing Address - Street 1:17 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2412
Mailing Address - Country:US
Mailing Address - Phone:508-686-5100
Mailing Address - Fax:508-927-6401
Practice Address - Street 1:17 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2412
Practice Address - Country:US
Practice Address - Phone:508-686-5100
Practice Address - Fax:508-927-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208015171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty