Basic Information
| Provider Information | |||||||||
| NPI: | 1578752200 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GERMAN L.NERI, MD | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| OtherOrganizationName: | GERMAN L NERI, MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| 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: | 10/18/2007 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | NERI | ||||||||
| AuthorizedOfficialFirstName: | GERMAN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2162263577 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 35-032276 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Legal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000127968 | 01 | OH | ANTHEM | OTHER | 100-38-4219-001 | 01 | OH | MEDICAL MUTUAL | OTHER | 000000127968 | 01 | OH | ANTHEM SENIOR ADVANTAGE | OTHER | 352453 | 01 | OH | WELLCARE | OTHER | 0178918 | 05 | OH | MEDICAID | 100-38-4219-00 | 01 | OH | CAREWORKS | OTHER | 100384219009 | 01 | OH | MEDICAL MUTUAL OF OHIO | OTHER | 100-38-4219-00 | 01 | OH | WORKERS COMPENSATION | OTHER | CG4786 | 01 | OH | MEDICARE RAILROAD | OTHER |