Provider Demographics
NPI:1578057865
Name:GOVANI KIDNEY CARE LLC
Entity Type:Organization
Organization Name:GOVANI KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN (SOLO MEMBER)
Authorized Official - Prefix:DR
Authorized Official - First Name:MAULIK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-223-5593
Mailing Address - Street 1:15644 MADISON AVE STE 211
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-5622
Mailing Address - Country:US
Mailing Address - Phone:734-223-5593
Mailing Address - Fax:216-521-5351
Practice Address - Street 1:15644 MADISON AVE STE 211
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5622
Practice Address - Country:US
Practice Address - Phone:734-223-5593
Practice Address - Fax:216-521-5351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134182207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty