Basic Information
Provider Information | |||||||||
NPI: | 1407886898 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NERI | ||||||||
FirstName: | GERMAN | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NERI | ||||||||
OtherFirstName: | GERMAN | ||||||||
OtherMiddleName: | L | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 14601 DETROIT AVE STE 730 | ||||||||
Address2: |   | ||||||||
City: | LAKEWOOD | ||||||||
State: | OH | ||||||||
PostalCode: | 441074251 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2162263577 | ||||||||
FaxNumber: | 2162263599 | ||||||||
Practice Location | |||||||||
Address1: | 14601 DETROIT AVE STE 730 | ||||||||
Address2: |   | ||||||||
City: | LAKEWOOD | ||||||||
State: | OH | ||||||||
PostalCode: | 441074251 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2162263577 | ||||||||
FaxNumber: | 2162263599 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/03/2006 | ||||||||
LastUpdateDate: | 12/22/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35-032276 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 0178918 | 05 | OH |   | MEDICAID | P00717465 | 01 | OH | RAILROAD CARE | OTHER |