MEDICARE: INTEGRATIVE MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1376487439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE MEDICINE LLC

Provider Business Mailing Address
First Line	:	1004 FIRST COLONIAL RD STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3070
Country	:	US
Telephone Number	:	757-792-7150
Fax Number	:	757-765-6027

Provider Business Practice Location Address
First Line	:	1004 FIRST COLONIAL RD STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3070
Country	:	US
Telephone Number	:	757-792-7150
Fax Number	:	757-765-6027

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. MICHEL G MOREAU
Credential	:	MD
Telephone Number	:	757-792-7150

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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