Healthcare Provider Details

I. General information

NPI: 1992340517
Provider Name (Legal Business Name): INTEGRATIVE CARE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W COLONIAL DR STE 302
ORLANDO FL
32804-6863
US

IV. Provider business mailing address

425 W COLONIAL DR STE 302
ORLANDO FL
32804-6863
US

V. Phone/Fax

Practice location:
  • Phone: 407-601-1370
  • Fax:
Mailing address:
  • Phone: 407-601-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER GANPAT
Title or Position: PHYSICIAN
Credential: MD
Phone: 407-601-1370