Healthcare Provider Details

I. General information

NPI: 1336886068
Provider Name (Legal Business Name): MINERVA NEUROLOGICAL INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 05/15/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21605 W 13 MILE RD
BEVERLY HILLS MI
48025-4805
US

IV. Provider business mailing address

21605 W 13 MILE RD
BEVERLY HILLS MI
48025-4805
US

V. Phone/Fax

Practice location:
  • Phone: 248-225-5745
  • Fax: 855-703-1986
Mailing address:
  • Phone: 248-225-5745
  • Fax: 855-703-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARUN KUMAR SHERMA
Title or Position: CHAIRMAN
Credential: MD
Phone: 248-225-5745