Organization
INNOVATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE SNYDER (BILLING MANAGER)
(765) 413-7100
Entity
Organization
Contact information
Practice address
3554 PROMENADE PKWY STE H, LAFAYETTE, IN 47909-8418
(765) 471-1100
(765) 471-1009
Mailing address
3554 PROMENADE PKWY STE H, LAFAYETTE, IN 47909-8418
(765) 471-1100
(765) 471-1009
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
—
—
207QA0505X
Adult Medicine Physician
—
—
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144372863
ROBERT CHARLES TURNER MD
IN
01
—
1720219702
MELISSA GALBRETH LMHC
IN
Enumeration date
06/12/2017
Last updated
04/18/2024
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