Provider Demographics
NPI:1306569546
Name:INTEGUMED LLC
Entity type:Organization
Organization Name:INTEGUMED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:765-251-3987
Mailing Address - Street 1:12315 HANCOCK ST STE 24
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5885
Mailing Address - Country:US
Mailing Address - Phone:317-708-3732
Mailing Address - Fax:888-316-7962
Practice Address - Street 1:606 E GRANT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2950
Practice Address - Country:US
Practice Address - Phone:765-251-3987
Practice Address - Fax:888-316-7962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300076258Medicaid