Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Medical |
363AM0700X | 97 | Physician Assistant |
| NPI # | 1679707947 |
| LBN Legal business name | INTEGRATIVE MEDICINE CONSULTANTS, INC. |
| Authorized official | MARY WINEGARDNER - (PRESIDENT/PROVIDER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 05/14/2009 |
| Last updated | 06/22/2009 - About 17 years ago |
| Identifiers | n/a |
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