Provider Demographics
NPI:1609322684
Name:INNOVATIVE GYNECOLOGY & OBSTETRICS, PA
Entity Type:Organization
Organization Name:INNOVATIVE GYNECOLOGY & OBSTETRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-529-1338
Mailing Address - Street 1:825 WHISPER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-5651
Mailing Address - Country:US
Mailing Address - Phone:863-529-1338
Mailing Address - Fax:
Practice Address - Street 1:1718 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5948
Practice Address - Country:US
Practice Address - Phone:863-529-1338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty