Provider Demographics
NPI:1649486879
Name:NERVES, LLC
Entity type:Organization
Organization Name:NERVES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GUNWANT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-942-0132
Mailing Address - Street 1:PO BOX 712844
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-2844
Mailing Address - Country:US
Mailing Address - Phone:614-942-0132
Mailing Address - Fax:614-942-0139
Practice Address - Street 1:450 ALKYRE RUN
Practice Address - Street 2:SUITE 300
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6909
Practice Address - Country:US
Practice Address - Phone:614-942-0132
Practice Address - Fax:614-942-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2756218Medicaid
OH2756218Medicaid