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NPI Code Detail

MEDICARE: DR. CHARLES JOHN GARVEN MD

MEDICARE: DR. CHARLES JOHN GARVEN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35055675OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000480954OTHEROHANTHEM BC/BS
2P00705931OTHEROHRAILROAD CARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4341542312138OTHEROHCARESOURCE

General Provider Information

NPI Number : 1568442861
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES JOHN GARVEN MD
Provider Business Mailing Address
First Line : 11851 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-3016
Country : US
Telephone Number : 216-529-7125
Fax Number : 216-529-7196
Provider Business Practice Location Address
First Line : 11851 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-3016
Country : US
Telephone Number : 216-529-7125
Fax Number : 216-529-7196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2006
Last Update Date : 06/26/2009

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