Healthcare Provider Details

I. General information

NPI: 1235318304
Provider Name (Legal Business Name): INTEGRATIVE PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 S MAIN ST 2ND FLOOR
ANN ARBOR MI
48104-3725
US

IV. Provider business mailing address

1310 S MAIN ST 2ND FLOOR
ANN ARBOR MI
48104-3725
US

V. Phone/Fax

Practice location:
  • Phone: 734-786-3833
  • Fax: 734-994-8622
Mailing address:
  • Phone: 734-786-3833
  • Fax: 734-994-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301063144
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number5101016620
License Number StateMI

VIII. Authorized Official

Name: DR. RICHARD LEWIS LINSK
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 734-786-3833