Provider Demographics
NPI:1043687767
Name:NEMOU MEDICAL LLC
Entity type:Organization
Organization Name:NEMOU MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEMOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-898-9801
Mailing Address - Street 1:231 RIVERSIDE DRIVE
Mailing Address - Street 2:APT 2309
Mailing Address - City:HOLLY HILL
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:330-774-3371
Mailing Address - Fax:
Practice Address - Street 1:231 RIVERSIDE DR UNIT 2309
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:FL
Practice Address - Zip Code:32117-4964
Practice Address - Country:US
Practice Address - Phone:330-774-3371
Practice Address - Fax:888-959-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 109018OtherMEDICAL LICENSE