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General NPI Number Information
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NPI Number | 1912201310
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Entity Type | Organization
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Legal Business Name | NATIONAL CENTER FOR INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 3100 THEODORE ST
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City | JOLIET
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State | IL
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Zip | 60435-8534
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Country | US
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Telephone | 815-330-3100
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Fax | 815-330-3115
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Provider Business Mailing Address
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Address Line | 3100 THEODORE ST
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City | JOLIET
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State | IL
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Zip | 60435-8534
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Country | US
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Telephone | 815-330-3100
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Fax | 815-330-3115
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. RAO KILARU
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Credential | M.D.
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Telephone | 815-330-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 38.011832
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 36.113633
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 85.003604
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 36.060189
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License Number State | IL
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