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General NPI Number Information
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NPI Number | 1730783556
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Entity Type | Organization
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Legal Business Name | INTEGRATED INDEPENDENT PHYSICIANS NETWORK, LLC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 1101 N LAKE DESTINY RD STE 300
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City | MAITLAND
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State | FL
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Zip | 32751-7121
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Country | US
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Telephone | 407-475-9213
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Fax | 407-475-9203
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Provider Business Mailing Address
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Address Line | 1101 N LAKE DESTINY RD STE 300
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City | MAITLAND
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State | FL
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Zip | 32751-7121
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Country | US
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Telephone | 407-475-9213
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Fax | 407-475-9203
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Authorized Official
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Title or Position | EXECUTIVE ASSISTA NT
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Name | KATHY MONNETT
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Credential |
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Telephone | 407-475-9213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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