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1548384100 NPI number — INTEGRATIVE MEDICINE CENTER

NPI Number: 1548384100
Health Care Provider/Practitioner: INTEGRATIVE MEDICINE CENTER

Information about “1548384100” NPI (INTEGRATIVE MEDICINE CENTER) exists in 1548384100 in HTML format HTML  |  1548384100 in plain Text format TXT  |  1548384100 in PDF (Portable Document Format) PDF  |  1548384100 in an XML format XML  formats.

NPI Number : 1548384100 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548384100",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "INTEGRATIVE MEDICINE CENTER",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9371 CYPRESS LAKE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT MYERS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33919-4939",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "239-274-3413",
    "MailingAddressFaxNumber": "239-415-8661",
    "FirstLinePracticeLocationAddress": "9371 CYPRESS LAKE DR STE 13",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT MYERS",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33919-4995",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "239-274-3413",
    "PracticeLocationAddressFaxNumber": "239-415-8661",
    "EnumerationDate": "03/19/2007",
    "LastUpdateDate": "09/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "OKONSKI",
    "AuthorizedOfficialFirstName": "LIDIA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "PHYSICIAN",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D",
    "AuthorizedOfficialTelephoneNumber": "239-274-3413",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "171100000X",
          "TaxonomyName": "Acupuncturist",
          "LicenseNumber": "001033 AP",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "146D00000X",
          "TaxonomyName": "Personal Emergency Response Attendant",
          "LicenseNumber": "ME 36300",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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