Healthcare Provider Details

I. General information

NPI: 1083533137
Provider Name (Legal Business Name): INTEGRATED LONG TERM CARE ACO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 E TRIPOLI AVE
ST FRANCIS WI
53235-4142
US

IV. Provider business mailing address

401 N MICHIGAN AVE STE 1200
CHICAGO IL
60611-4264
US

V. Phone/Fax

Practice location:
  • Phone: 941-380-0606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: AMISH PATEL
Title or Position: CEO
Credential: DO
Phone: 941-380-0606