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General NPI Number Information
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NPI Number | 1376588244
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Entity Type | Organization
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Legal Business Name | INTEGRITY MEDICAL GROUP, S.C.
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 1370 N. SHAWANO ST STE A
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City | NEW LONDON
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State | WI
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Zip | 54961-7943
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Country | US
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Telephone | 920-531-1100
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Fax | 920-531-8310
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Provider Business Mailing Address
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Address Line | 1370 N. SHAWANO ST STE A
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City | NEW LONDON
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State | WI
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Zip | 54961-7943
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Country | US
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Telephone | 920-531-1100
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Fax | 920-531-8310
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY B RASOR
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Credential | M.D.
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Telephone | 920-982-2491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 27767-020
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License Number State | WI
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