# MINDFUL INTEGRATED MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831544832
- **Authorized official:** MS. IVETTE A CHARNECO (OFFICE ADMINISTRATOR)
- **Authorized official phone:** (407) 846-0533

## Contact information

- **Practice address:** 711 E OAK ST, KISSIMMEE, FL 34744-4573
- **Practice address phone:** (407) 846-0533
- **Practice address fax:** (407) 518-1730
- **Mailing address:** 719 E OAK ST, KISSIMMEE, FL 34744-4580
- **Mailing address phone:** (407) 846-0533
- **Mailing address fax:** (407) 518-1730

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | — | — |
| 261QP2300X | Primary Care Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 04/27/2016
- **Last updated:** 10/04/2016