Provider Demographics
NPI:1982685541
Name:JAWA, PREM S (MD)
Entity Type:Individual
Prefix:DR
First Name:PREM
Middle Name:S
Last Name:JAWA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9500 EUCLID AVE/Q10-1
Mailing Address - Street 2:GLICKMAN UROLOGICAL & KIDNEY INSTITUTE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195
Mailing Address - Country:US
Mailing Address - Phone:216-444-0221
Mailing Address - Fax:216-636-4492
Practice Address - Street 1:9500 EUCLID AVE/Q10-1
Practice Address - Street 2:GLICKMAN UROLOGICAL & KIDNEY INSTITUTE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-0221
Practice Address - Fax:216-636-4492
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2011-06-15
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Provider Licenses
StateLicense IDTaxonomies
OH35037561J208800000X
OH35-03-7561J208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0309615Medicaid
OH0309615Medicaid
A75402Medicare UPIN
OHJA0415005Medicare ID - Type Unspecified