Healthcare Provider Details

I. General information

NPI: 1548384100
Provider Name (Legal Business Name): INTEGRATIVE MEDICINE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9371 CYPRESS LAKE DR STE 13
FORT MYERS FL
33919-4995
US

IV. Provider business mailing address

9371 CYPRESS LAKE DR
FORT MYERS FL
33919-4939
US

V. Phone/Fax

Practice location:
  • Phone: 239-274-3413
  • Fax: 239-415-8661
Mailing address:
  • Phone: 239-274-3413
  • Fax: 239-415-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001033 AP
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberME 36300
License Number StateFL

VIII. Authorized Official

Name: DR. LIDIA OKONSKI
Title or Position: PHYSICIAN
Credential: M.D
Phone: 239-274-3413