Integrative Immunity Health System PC

Primary specialty

Allergy PhysicianTaxonomy code 207KA0200X

License

56126 Issued in MN

Legal business name

INTEGRATIVE IMMUNITY HEALTH SYSTEM PC

Practice address

3939 W 69TH St Unit B
Edina, MN 55435-2001

Phone

(952) 222-3879

Fax

(952) 222-3919

NPI assigned

Oct 6, 2015

Last updated

Sep 20, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Benoit D Tano, MD

Title

MD/Owner

Phone

(952) 222-3879

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1444089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1265802052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 W 18TH ST STE 100",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571050602",
            "telephone_number": "952-222-3879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 W 69TH ST UNIT B",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352001",
            "telephone_number": "952-222-3879",
            "fax_number": "952-222-3919"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10850 Rhode Island Ave S",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554382300",
            "country_code": "US",
            "telephone_number": "903-705-3500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4503 Coleman St Ste 208",
            "address_purpose": "LOCATION",
            "city": "Bismarck",
            "state": "ND",
            "postal_code": "585032007",
            "country_code": "US",
            "telephone_number": "952-222-3879",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "625 W 18th St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Sioux Falls",
            "state": "SD",
            "postal_code": "571050602",
            "country_code": "US",
            "telephone_number": "855-372-8266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTEGRATIVE IMMUNITY HEALTH SYSTEM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-06",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "TANO",
        "authorized_official_first_name": "BENOIT",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "952-222-3879",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "MN",
            "license": "56126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.