MEDICARE: FLORIDA INTEGRATIVE MEDICAL CENTER INC

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1902812662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA INTEGRATIVE MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	2415 UNIVERSITY PKWY
Second Line	:	SUITE 218
City	:	SARASOTA
State	:	FL
Zip	:	34243-2809
Country	:	US
Telephone Number	:	941-955-6220
Fax Number	:	941-955-1410

Provider Business Practice Location Address
First Line	:	2415 UNIVERSITY PKWY
Second Line	:	SUITE 218
City	:	SARASOTA
State	:	FL
Zip	:	34243-2809
Country	:	US
Telephone Number	:	941-955-6220
Fax Number	:	941-955-1410

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN PYLANT MONHOLLON
Credential	:	M.D.
Telephone Number	:	941-955-6220

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	04/07/2015

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