MEDICARE: NATWARLAL JETHVA MD

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	207R00000X	Internal Medicine Physician	35047059J	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
4	3610861	OTHER	GROUP ASC MEDICARE
10	9273172	OTHER	GROUP MEDICARE
13	CA4511	OTHER	RR MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	D368301	OTHER	GROUP IND DIAGNOSTICS MED
3	F47159	OTHER	SUMMACARE APEX
5	1780634279	OTHER	GROUP NPI
6	102565	OTHER	KAISER
7	000000202033	OTHER	ANTHEM
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	11389457	OTHER	CAQH
11	0636990	OTHER	AETNA
12	341783789037	OTHER	CARESOURCE

General Provider Information

NPI Number	:	1982671186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATWARLAL JETHVA MD

Provider Business Mailing Address
First Line	:	20525 CENTER RIDGE ROAD
Second Line	:	SUITE 220
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116
Country	:	US
Telephone Number	:	440-895-5056
Fax Number	:	440-333-2935

Provider Business Practice Location Address
First Line	:	18660 BAGLEY ROAD
Second Line	:	SUITE 102 A
City	:	MIDDLEBURG HTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	440-239-1972
Fax Number	:	440-239-8105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	01/10/2008

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Directions to “ NATWARLAL JETHVA MD” Practice Location

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