Provider Demographics
NPI:1003132143
Name:BOCA INTEGRATIVE HEALTH
Entity type:Organization
Organization Name:BOCA INTEGRATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JED
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:561-391-2770
Mailing Address - Street 1:7100 W CAMINO REAL
Mailing Address - Street 2:STE. 207
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-391-2770
Mailing Address - Fax:561-391-2930
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:STE. 207
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-391-2770
Practice Address - Fax:561-391-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty