Provider Demographics
NPI:1063239044
Name:INTEGRATIVE IMMUNOLOGY CARE PLLC
Entity type:Organization
Organization Name:INTEGRATIVE IMMUNOLOGY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-910-1402
Mailing Address - Street 1:8810 BLAKENEY PROFESSIONAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6596
Mailing Address - Country:US
Mailing Address - Phone:704-910-1402
Mailing Address - Fax:704-910-1506
Practice Address - Street 1:8810 BLAKENEY PROFESSIONAL DR STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6596
Practice Address - Country:US
Practice Address - Phone:704-910-1402
Practice Address - Fax:704-910-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty