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General NPI Number Information
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NPI Number | 1205656261
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICINE FOR MENS HEALTH
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 2838 45TH ST STE A
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City | HIGHLAND
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State | IN
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Zip | 46322-2905
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Country | US
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Telephone | 219-424-1488
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Fax | 219-267-1704
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Provider Business Mailing Address
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Address Line | 226 INDIAN TRAIL RD
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City | OAK BROOK
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State | IL
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Zip | 60523-2796
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Country | US
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Telephone | 219-424-1488
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Fax | 219-267-1704
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAJAT PRAKASH
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Credential | MD
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Telephone | 219-424-1488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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