Provider Demographics
NPI:1033433826
Name:INNOVATIVE HEALTH PARTNERS LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH PARTNERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:VELARDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-343-2280
Mailing Address - Street 1:4802 E RAY RD
Mailing Address - Street 2:STE 23, PMB 289
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6405
Mailing Address - Country:US
Mailing Address - Phone:480-343-2280
Mailing Address - Fax:480-284-8406
Practice Address - Street 1:2050 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220
Practice Address - Country:US
Practice Address - Phone:480-237-3200
Practice Address - Fax:480-237-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22015208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ392689Medicaid
AZ392689Medicaid
AZ72482Medicare PIN