Functional Medicine of Carmel Inc.

Primary specialty

Obstetrics PhysicianTaxonomy code 207VX0000X

License

02001906A Issued in IN

Legal business name

FUNCTIONAL MEDICINE OF CARMEL INC.

Doing business as

BodylogicMD of Carmel

Practice address

755 W Carmel Dr
Suite 212
Carmel, IN 46032-5877

Phone

(765) 318-3265

NPI assigned

Jun 10, 2015

Last updated

Jun 10, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lynnova Reynolds, D.O.

Title

President

Phone

(765) 318-3265

Specialties & licenses 1

Addresses

Other names 1

• BodylogicMD of Carmel Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433894400000",
    "number": "1871974337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "755 W CARMEL DR",
            "address_2": "SUITE 212",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460325877",
            "telephone_number": "765-318-3265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 W CARMEL DR",
            "address_2": "SUITE 212",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460325877",
            "telephone_number": "765-318-3265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL MEDICINE OF CARMEL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-10",
        "last_updated": "2015-06-10",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "LYNNOVA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "765-318-3265",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "IN",
            "license": "02001906A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BodylogicMD of Carmel",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Stephanie Elizabeth Gagnon, M.A.
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• Obstetrics Physician in Carmel, IN
• Providers in Carmel, IN by specialty
• Obstetrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.