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General NPI Number Information
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NPI Number | 1275960908
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Entity Type | Organization
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Legal Business Name | GREAT RIVER CARDIOLOGY, INC
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 24700 CENTER RIDGE RD STE 220
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City | WESTLAKE
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State | OH
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Zip | 44145-5669
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Country | US
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Telephone | 440-333-7315
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Fax | 440-808-8303
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Provider Business Mailing Address
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Address Line | 24700 CENTER RIDGE RD STE 220
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City | WESTLAKE
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State | OH
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Zip | 44145-5669
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Country | US
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Telephone | 440-333-7315
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Fax | 440-808-8303
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Authorized Official
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Title or Position | OWNER
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Name | DR. ASHOKA NAUTIYAL
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Credential | M.D.
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Telephone | 440-333-7315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35086804
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 35086804
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 35086804
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License Number State | OH
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