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General NPI Number Information
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NPI Number | 1568866150
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Entity Type | Organization
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Legal Business Name | IAM INTEGRATIVE & AESTHETIC MEDICINE, LTD.
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Dates
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Enumeration Date | 10/10/2014
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Last Update Date | 10/10/2014
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Provider Practice Location Address
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Address Line | 10602 N PORT WASHINGTON RD STE. 101
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City | MEQUON
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State | WI
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Zip | 53092-5079
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Country | US
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Telephone | 415-866-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 10602 N PORT WASHINGTON RD STE. 101
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City | MEQUON
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State | WI
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Zip | 53092-5079
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADAM C MILLER
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Credential | MD
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Telephone | 415-866-8757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 6702-20
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License Number State | WI
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