Provider Demographics
NPI:1265802052
Name:INTEGRATIVE IMMUNITY HEALTH SYSTEM PC
Entity type:Organization
Organization Name:INTEGRATIVE IMMUNITY HEALTH SYSTEM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENOIT
Authorized Official - Middle Name:D
Authorized Official - Last Name:TANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-222-3879
Mailing Address - Street 1:625 W 18TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0602
Mailing Address - Country:US
Mailing Address - Phone:952-222-3879
Mailing Address - Fax:
Practice Address - Street 1:3939 W 69TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2001
Practice Address - Country:US
Practice Address - Phone:952-222-3879
Practice Address - Fax:952-222-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56126207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty