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General NPI Number Information
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NPI Number | 1932352499
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE FAMILY HEALTH ASSOCIATES
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 4727 WILLOW SPRINGS RD UNIT 3S/4S
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City | LA GRANGE
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State | IL
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Zip | 60525-6140
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Country | US
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Telephone | 630-417-6022
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Fax |
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Provider Business Mailing Address
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Address Line | 1212 N LASALLE ST 1001
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City | CHICAGO
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State | IL
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Zip | 60610-8027
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Country | US
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Telephone | 312-202-0774
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. KORI FELDMAN
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Credential | M.D.
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Telephone | 630-417-6022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036116890
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License Number State | IL
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