Integrative Physical Medicine Of Lake Mary LLC
Specialist in Lake Mary, FL. Organization (NPI-2).
NPI number1487907010
StatusActive
Last updated in NPPESNov 20, 2012
Details
- NPI
- 1487907010
- Entity type
- Organization (NPI-2)
- Legal business name
- Integrative Physical Medicine Of Lake Mary LLC
- Organization subpart
- No
- Enumeration date
- Oct 19, 2012
- Last updated
- Nov 20, 2012
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | – | – | Yes |
Practice location
1343 S International PkwySuite 1351-B
Lake Mary, FL 32746-1401
Phone 407-792-0705 · Fax 407-792-0710
Mailing address
1343 S International PkwySuite 1351-B
Lake Mary, FL 32746-1401
Phone 407-792-0705 · Fax 407-792-0710
Authorized official
Marc Ott
President
4079773434
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