Basic Information
| Provider Information | |||||||||
| NPI: | 1083024400 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MERITRA CLINICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 COMMERCE PARK DR | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430828349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148829355 | ||||||||
| FaxNumber: | 6148829576 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 COMMERCE PARK DR | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430828349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148829355 | ||||||||
| FaxNumber: | 6148829576 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2014 | ||||||||
| LastUpdateDate: | 01/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | BEKKAM | ||||||||
| AuthorizedOfficialFirstName: | NAVEEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8667274612 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.