Provider Demographics
NPI:1609222546
Name:PORWAL, NIVIN
Entity Type:Individual
Prefix:
First Name:NIVIN
Middle Name:
Last Name:PORWAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 ORLEANS ST APT 1811E
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3022
Mailing Address - Country:US
Mailing Address - Phone:614-256-1951
Mailing Address - Fax:
Practice Address - Street 1:1301 ORLEANS ST APT 1811E
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3022
Practice Address - Country:US
Practice Address - Phone:614-256-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18913208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation