Innovative Professional Service LLC

NPI #1679836910 in Fort Wayne, Indiana

Provider Information

NPI Number: 1679836910
Entity Type: Organization
Organization Name: Innovative Professional Service LLC
Primary Specialty: General Practice
Enumeration Date: Jun 21, 2012
Last Updated: Jun 21, 2012

Practice Location

Address: 3464 STELLHORN RD
City: Fort Wayne
State: Indiana
ZIP Code: 46815-4630
Phone: (260) 432-6508

Authorized Official

Name: MR. TERRY YEITER
Title: OFFICE MANAGER
Phone: (260) 432-6508

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
General Practice	208D00000X	Primary

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