MEDICARE: INNOTIV GERMIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	7866	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225101330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOTIV GERMIN

Provider Business Mailing Address
First Line	:	PO BOX 530786
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89053-0786
Country	:	US
Telephone Number	:	702-804-1212
Fax Number	:	702-804-1222

Provider Business Practice Location Address
First Line	:	1691 W HORIZON RIDGE PKWY
Second Line	:	#100
City	:	HENDERSON
State	:	NV
Zip	:	89012-3494
Country	:	US
Telephone Number	:	702-804-1212
Fax Number	:	702-804-1222

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MR. LEO GERMIN
Credential	:	M.D.
Telephone Number	:	702-804-1212

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	01/20/2016

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