Provider Demographics
NPI:1740436831
Name:INNOVATIVE GYNECOLOGY LLC
Entity type:Organization
Organization Name:INNOVATIVE GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-388-3332
Mailing Address - Street 1:709 SEBASTIAN BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-8704
Mailing Address - Country:US
Mailing Address - Phone:772-388-3332
Mailing Address - Fax:772-388-3356
Practice Address - Street 1:709 SEBASTIAN BLVD STE F
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-8704
Practice Address - Country:US
Practice Address - Phone:772-388-3332
Practice Address - Fax:772-388-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10268207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48171OtherBLUE CROSS BLUE SHIELD OF FL