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NPI Code Detail

MEDICARE: MINDFUL INTEGRATED MEDICINE LLC

MEDICARE: MINDFUL INTEGRATED 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
1261QP2300XPrimary Care Clinic/Center
2261Q00000XClinic/Center
3208000000XPediatrics Physician
4208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1831544832
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDFUL INTEGRATED MEDICINE LLC
Provider Business Mailing Address
First Line : 719 E OAK ST
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-4580
Country : US
Telephone Number : 407-846-0533
Fax Number : 407-518-1730
Provider Business Practice Location Address
First Line : 711 E OAK ST
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-4573
Country : US
Telephone Number : 407-846-0533
Fax Number : 407-518-1730
Authorized Official
Title or Position : OFFICE ADMINISTRATOR
Name : MS. IVETTE A CHARNECO
Credential :
Telephone Number : 407-846-0533
Provider Enumeration Date : 04/27/2016
Last Update Date : 10/04/2016

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Directions to “MINDFUL INTEGRATED MEDICINE LLC ” Practice Location

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