Healthcare Provider Details

I. General information

NPI: 1982671186
Provider Name (Legal Business Name): NATWARLAL JETHVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18660 BAGLEY ROAD SUITE 102 A
MIDDLEBURG HTS OH
44130
US

IV. Provider business mailing address

20525 CENTER RIDGE ROAD SUITE 220
ROCKY RIVER OH
44116
US

V. Phone/Fax

Practice location:
  • Phone: 440-239-1972
  • Fax: 440-239-8105
Mailing address:
  • Phone: 440-895-5056
  • Fax: 440-333-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35047059J
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: