Provider Demographics
NPI:1699306126
Name:INTEGRATED MEDICINE OF OHIO LLC
Entity type:Organization
Organization Name:INTEGRATED MEDICINE OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOARDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-236-0060
Mailing Address - Street 1:6200 ROCKSIDE WOODS BLVD N STE 100
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2392
Mailing Address - Country:US
Mailing Address - Phone:216-236-0060
Mailing Address - Fax:216-236-0067
Practice Address - Street 1:6200 ROCKSIDE WOODS BLVD N STE 100
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2392
Practice Address - Country:US
Practice Address - Phone:216-236-0060
Practice Address - Fax:216-236-0067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED MEDICINE OF OHIO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty