Organization
INNOVATIVE PROFESSIONAL SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY YEITER (OFFICE MANAGER)
(260) 432-6508
Entity
Organization
Contact information
Practice address
3464 STELLHORN RD, FORT WAYNE, IN 46815-4630
(260) 432-6508
(260) 432-6586
Mailing address
3464 STELLHORN RD, FORT WAYNE, IN 46815-4630
(260) 432-6508
(260) 432-6586
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
01025672
IN
Other
Enumeration date
06/21/2012
Last updated
06/21/2012
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