Provider Demographics
NPI:1093060717
Name:INTEGRATIVE HEALTH INSTITUTE LLC
Entity type:Organization
Organization Name:INTEGRATIVE HEALTH INSTITUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-222-4600
Mailing Address - Street 1:7659 E PINNACLE PEAK RD
Mailing Address - Street 2:STE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6297
Mailing Address - Country:US
Mailing Address - Phone:480-222-4600
Mailing Address - Fax:480-222-4619
Practice Address - Street 1:7659 E PINNACLE PEAK RD
Practice Address - Street 2:STE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6297
Practice Address - Country:US
Practice Address - Phone:480-222-4600
Practice Address - Fax:480-222-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005257208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ157440Medicare PIN