NPI Profile for INNOVATIVE MEDICINE in LAFAYETTE, IN.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Addiction Medicine |
207QA0401X | 08 | Physician/Family Practice | |
Adult Medicine |
207QA0505X | 08 | Physician/Family Practice | |
Bariatric Medicine |
207QB0002X | 08 | Physician/Family Practice | |
Non-Pharmacy Dispensing Site |
332900000X | 87 | All Other Suppliers |
| NPI # | 1417486523 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 06/12/2017 | |
| Last updated | 04/18/2024 - About 2 years ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers |
|
|
| Hospital affiliation(s) | Not Available |
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INNOVATIVE MEDICINE
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