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NPI Code Detail

MEDICARE: INTERNATIONAL CENTER FOR HEALTH & WELLNESS LLC

MEDICARE: INTERNATIONAL CENTER FOR HEALTH & WELLNESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianOS5181FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11932190519OTHERFLNPI ALAN W GRUNING DO
21497746804OTHERFLNPI MARY L HARDEN

General Provider Information

NPI Number : 1437328341
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERNATIONAL CENTER FOR HEALTH & WELLNESS LLC
Provider Business Mailing Address
First Line : PO BOX 7146
Second Line :
City : FORT MYERS
State : FL
Zip : 33911-7146
Country : US
Telephone Number : 239-939-3303
Fax Number : 239-939-7373
Provider Business Practice Location Address
First Line : 3677 CENTRAL AVE
Second Line : SUITE E
City : FORT MYERS
State : FL
Zip : 33901-8226
Country : US
Telephone Number : 239-939-3303
Fax Number : 239-939-7373
Authorized Official
Title or Position : PRESIDENT
Name : DR. ALAN W GRUNING
Credential : DO
Telephone Number : 239-939-3303
Provider Enumeration Date : 02/25/2008
Last Update Date : 03/04/2008

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Directions to “INTERNATIONAL CENTER FOR HEALTH & WELLNESS LLC ” Practice Location

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