Provider Demographics
NPI:1396922183
Name:BRADENTON EAST INTEGRATIVE MEDICINE
Entity type:Organization
Organization Name:BRADENTON EAST INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:O
Authorized Official - Last Name:BRAINARD
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:941-807-8066
Mailing Address - Street 1:8614 EAST STATE ROAD 70
Mailing Address - Street 2:STE 200
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3710
Mailing Address - Country:US
Mailing Address - Phone:941-727-1243
Mailing Address - Fax:941-751-9039
Practice Address - Street 1:8614 EAST STATE ROAD 70
Practice Address - Street 2:STE 200
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3710
Practice Address - Country:US
Practice Address - Phone:941-727-1243
Practice Address - Fax:941-751-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAJ675Medicare PIN