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General NPI Number Information
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NPI Number | 1679993810
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICAL CONSULTANTS
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 01/17/2017
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Provider Practice Location Address
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Address Line | 1219 S EAST AVE SUITE 301
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City | SARASOTA
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State | FL
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Zip | 34239-2340
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Country | US
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Telephone | 941-225-4327
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Fax |
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Provider Business Mailing Address
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Address Line | 1219 S EAST AVE SUITE 301
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City | SARASOTA
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State | FL
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Zip | 34239-2340
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Country | US
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Telephone | 941-225-4327
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACY ANN VASILE
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Credential | DO
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Telephone | 941-225-4327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | FL
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