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Organization
INTEGRATIVE MEDICAL ASSOCIATES OF ROCKFORD, LLC
Active
Organization
INTEGRATIVE MEDICAL ASSOCIATES OF ROCKFORD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN T NITZ PHYSICIAN (CEO)
(815) 289-4697
Entity
Organization
Contact information
Practice address
1639 N ALPINE RD, SUITE 502, ROCKFORD, IL 61107-1449
(815) 289-4697
Mailing address
4007 CUSHMAN CLOSE, ROCKFORD, IL 61114-6106
(815) 289-4697
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036105695
PHYSICIAN LICENSE
IL
Enumeration date
01/23/2014
Last updated
01/23/2014
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