| Integrative Medical Associates Of Rockford, Llc | |
|
1639 N Alpine Rd Suite 502 Rockford IL 61107-1449 | |
| (815) 289-4697 | |
| Not Available |
| Full Name | Integrative Medical Associates Of Rockford, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1639 N Alpine Rd, Rockford, Illinois |
| Authorized Official Name and Position | Stephen T Nitz (CEO) |
| Authorized Official Contact | 8152894697 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Integrative Medical Associates Of Rockford, Llc 4007 Cushman Close Rockford IL 61114-6106 Ph: (815) 289-4697 | Integrative Medical Associates Of Rockford, Llc 1639 N Alpine Rd Suite 502 Rockford IL 61107-1449 Ph: (815) 289-4697 |
| NPI Number | 1164845459 |
|---|---|
| Provider Enumeration Date | 01/23/2014 |
| Last Update Date | 01/23/2014 |
| Medicare PECOS PAC ID | 4688997976 |
|---|---|
| Medicare Enrollment ID | O20141217001149 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164845459 | NPI | - | NPPES |
| 036105695 | Other | IL | PHYSICIAN LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Stephen T Nitz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518958651 PECOS PAC ID: 7719060144 Enrollment ID: I20080208000211 |
| Provider Name | Lorie R Wendt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831418243 PECOS PAC ID: 8022206598 Enrollment ID: I20101228000287 |
| Provider Name | Stacey J Caler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336652700 PECOS PAC ID: 9739446436 Enrollment ID: I20171206000045 |
| Provider Name | Stephanie Yeager |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508368309 PECOS PAC ID: 1557625324 Enrollment ID: I20180502000984 |
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