Provider Demographics
NPI:1639659303
Name:INNOVATIVE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAIRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-490-9096
Mailing Address - Street 1:9677 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-2526
Mailing Address - Country:US
Mailing Address - Phone:727-490-9096
Mailing Address - Fax:727-490-9299
Practice Address - Street 1:9677 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-2526
Practice Address - Country:US
Practice Address - Phone:727-490-9096
Practice Address - Fax:727-490-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty