| Innovative Professional Service Llc | |
|
3464 Stellhorn Rd Fort Wayne IN 46815-4630 | |
| (260) 432-6508 | |
| (260) 432-6586 |
| Full Name | Innovative Professional Service Llc |
|---|---|
| Speciality | General Practice |
| Location | 3464 Stellhorn Rd, Fort Wayne, Indiana |
| Authorized Official Name and Position | Terry Yeiter (OFFICE MANAGER) |
| Authorized Official Contact | 2604326508 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Professional Service Llc 3464 Stellhorn Rd Fort Wayne IN 46815-4630 Ph: (260) 432-6508 | Innovative Professional Service Llc 3464 Stellhorn Rd Fort Wayne IN 46815-4630 Ph: (260) 432-6508 |
| NPI Number | 1679836910 |
|---|---|
| Provider Enumeration Date | 06/21/2012 |
| Last Update Date | 06/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679836910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 01025672 (Indiana) | Primary |
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