Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Innovative Medicine

Organization Addiction Medicine (Family Medicine) Physician · NPI 1417486523

Innovative Medicine is an Addiction Medicine (Family Medicine) Physician in Lafayette, Indiana. Registered with an NPI since 2017.

In the registry since
2017
Specialties on file
4

Practice location Address checks out

3554 Promenade Pkwy Ste H
Lafayette, IN 47909-8418
Phone: (765) 471-1100
Fax: (765) 471-1009
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction Medicine (Family Medicine) Physician (primary) Taxonomy 207QA0401X
Adult Medicine Physician Taxonomy 207QA0505X
Obesity Medicine (Family Medicine) Physician Taxonomy 207QB0002X
Non-Pharmacy Dispensing Site Taxonomy 332900000X

Record details

NPI number1417486523
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jacqueline Snyder — Billing Manager · (765) 413-7100
NPI enumeratedJune 12, 2017
Last updated in NPPESApril 18, 2024
Certification dateApril 18, 2024
Mailing address3554 Promenade Pkwy Ste H, Lafayette, IN 47909-8418