Healthcare Provider Details

I. General information

NPI: 1518950625
Provider Name (Legal Business Name): RONALD DEAN NERVIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W FRONT ST
TRAVERSE CITY MI
49684-2259
US

IV. Provider business mailing address

401 W FRONT ST
TRAVERSE CITY MI
49684-2259
US

V. Phone/Fax

Practice location:
  • Phone: 231-941-0230
  • Fax: 231-941-0230
Mailing address:
  • Phone: 231-941-0230
  • Fax: 231-941-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301030825
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17493
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: