Integrative Medical Group, Inc

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

A113632 Issued in CA

Legal business name

INTEGRATIVE MEDICAL GROUP, INC

Practice address

2200 W 3Rd St
Suite 120 a
Los Angeles, CA 90057-1932

Phone

(310) 905-3331

Fax

(310) 453-2916

NPI assigned

Aug 3, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ryan M Spivak, M.D

Title

Authorized Official

Phone

(310) 905-3331

Specialties & licenses 1

Addresses

Tax ID family

Integrative Medical Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Integrative Medical Group, Inc., a Professional Corporation

  • Plastic Surgery Physician
  • Los Angeles, CA
  • NPI 1013364397
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470182400000",
    "number": "1003369380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 W 3RD ST",
            "address_2": "SUITE 120 A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571932",
            "telephone_number": "310-905-3331",
            "fax_number": "310-453-2916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W 3RD ST",
            "address_2": "SUITE 120 A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571932",
            "telephone_number": "310-905-3331",
            "fax_number": "310-453-2916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-03",
        "last_updated": "2016-08-03",
        "status": "A",
        "authorized_official_last_name": "SPIVAK",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "310-905-3331",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "A113632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Rehabilitation Services LLC
• Integrative Endodontics, Inc
• Integrative Lifecare
• Integrative Lifecare Acupuncture, Inc.
• Integrative Medical Associates Inc
• Integrative Medical Group, Inc., a Professional Corporation
• Integrative Occupational Therapy Inc
• Integrative Surgical Associates Group, LLC.
• Integrity Health and Nursing of California, PC
• Integrity Treatment Program, LLC

• Plastic and Reconstructive Surgery Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Plastic and Reconstructive Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.