Integrative Pediatric Gi and Lifestyle Medicine

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

Legal business name

INTEGRATIVE PEDIATRIC GI AND LIFESTYLE MEDICINE

Practice address

1123 Villa Linde CT Ste 38
Flint, MI 48532-3410

Phone

(810) 733-7221

Fax

(810) 733-7280

NPI assigned

Jan 16, 2023

Organization subpart

No

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

Authorized official

Name

Rima Jibaly, MD

Title

Owner

Phone

(201) 931-5713

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1673827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673827200000",
    "number": "1386359263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7408 WATERFALL DR",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484397102",
            "telephone_number": "201-931-5713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 VILLA LINDE CT STE 38",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323410",
            "telephone_number": "810-733-7221",
            "fax_number": "810-733-7280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE PEDIATRIC GI AND LIFESTYLE MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-16",
        "last_updated": "2023-01-16",
        "certification_date": "2023-01-16",
        "status": "A",
        "authorized_official_last_name": "JIBALY",
        "authorized_official_first_name": "RIMA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "201-931-5713",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080P0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Gastroenterology Physician in Flint, MI
• Providers in Flint, MI by specialty
• Pediatric Gastroenterology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; 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.