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General NPI Number Information
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NPI Number | 1740436831
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Entity Type | Organization
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Legal Business Name | INNOVATIVE GYNECOLOGY LLC
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Dates
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Enumeration Date | 08/08/2008
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 709 SEBASTIAN BLVD STE F
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City | SEBASTIAN
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State | FL
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Zip | 32958-8704
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Country | US
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Telephone | 772-388-3332
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Fax | 772-388-3356
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Provider Business Mailing Address
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Address Line | 709 SEBASTIAN BLVD STE F
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City | SEBASTIAN
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State | FL
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Zip | 32958-8704
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Country | US
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Telephone | 772-388-3332
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Fax | 772-388-3356
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DEBORAH LOUISE KAUFMAN
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Credential | D.O.
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Telephone | 772-388-3332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | OS10268
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License Number State | FL
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