Provider Demographics
NPI:1194966275
Name:ABSOLUTE INTEGRATED MEDICINE, INC
Entity type:Organization
Organization Name:ABSOLUTE INTEGRATED MEDICINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:BURO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-770-6184
Mailing Address - Street 1:333 17TH ST
Mailing Address - Street 2:SUITE P
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5670
Mailing Address - Country:US
Mailing Address - Phone:772-770-6184
Mailing Address - Fax:772-770-6310
Practice Address - Street 1:333 17TH ST
Practice Address - Street 2:SUITE P
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5670
Practice Address - Country:US
Practice Address - Phone:772-770-6184
Practice Address - Fax:772-770-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7615208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG62310Medicare UPIN