INNOVATIVE PROFESSIONAL SERVICE LLC NPI 1679836910

NPI Information

INNOVATIVE PROFESSIONAL SERVICE LLC is a general practice in Fort Wayne, IN. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee INNOVATIVE PROFESSIONAL SERVICE LLC NPI is 1679836910. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3464 STELLHORN RD
FORT WAYNE, IN
ZIP 46815-630
Phone: (260) 432-6508
Fax: (260) 432-6586

The provider's authorized official is Terry Yeiter .
The authorized official title is Office Manager and has the following contact phone number (260) 432-6508.

The enumeration date for this NPI number is 6/21/2012 and was last updated on 6/21/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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