Healthcare Provider Details

I. General information

NPI: 1306053970
Provider Name (Legal Business Name): PURVA GROVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18101 LORAIN AVENUE, CLEVELAND CLINIC - FAIRVIEW HOSPIT EMERGENCY SERVICES
CLEVELAND OH
44111-5612
US

IV. Provider business mailing address

18101 LORAIN AVENUE, CLEVELAND CLINIC - FAIRVIEW HOSPIT EMERGENCY SERVICES
CLEVELAND OH
44111-5612
US

V. Phone/Fax

Practice location:
  • Phone: 216-476-7312
  • Fax:
Mailing address:
  • Phone: 216-476-7312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301084545
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35091526
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: