Provider Demographics
NPI:1194263962
Name:ALLIANCE INTEGRATED MEDICINE LLC
Entity type:Organization
Organization Name:ALLIANCE INTEGRATED MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RAVIKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRAVURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-888-2545
Mailing Address - Street 1:721 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3017
Mailing Address - Country:US
Mailing Address - Phone:772-888-2545
Mailing Address - Fax:772-888-2742
Practice Address - Street 1:721 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3017
Practice Address - Country:US
Practice Address - Phone:772-888-2545
Practice Address - Fax:772-888-2742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty