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General NPI Number Information
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NPI Number | 1932493236
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE MEDICAL OPTIONS LLC
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 01/24/2013
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Provider Practice Location Address
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Address Line | 305 N. 2ND ST
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City | ST. CHARLES
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State | IL
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Zip | 60174
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Country | US
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Telephone | 847-695-6262
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Fax | 847-695-6348
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Provider Business Mailing Address
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Address Line | 305 N 2ND ST
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City | ST CHARLES
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State | IL
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Zip | 60174-1844
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Country | US
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Telephone | 847-695-6262
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Fax | 847-695-6348
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ROBERT J. LACAVA
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Credential | M.D.
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Telephone | 847-695-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 036065641
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License Number State | IL
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