Organization
INNOVATIVE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK DALE (CO-OWNER)
(317) 407-6275
Entity
Organization
Contact information
Practice address
10105 QUAKER RIDGE CT, FISHERS, IN 46037-9484
(317) 407-6275
(317) 576-8147
Mailing address
10105 QUAKER RIDGE CT, FISHERS, IN 46037-9484
(317) 407-6275
(317) 576-8147
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/20/2010
Last updated
09/20/2010
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