Healthcare Provider Details

I. General information

NPI: 1043687767
Provider Name (Legal Business Name): NEMOU MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 RIVERSIDE DR UNIT 2309
HOLLY HILL FL
32117-4964
US

IV. Provider business mailing address

231 RIVERSIDE DRIVE APT 2309
HOLLY HILL FL
32117
US

V. Phone/Fax

Practice location:
  • Phone: 330-774-3371
  • Fax: 888-959-3690
Mailing address:
  • Phone: 330-774-3371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KHALIL NEMOU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 386-898-9801