Healthcare Provider Details

I. General information

NPI: 1184624041
Provider Name (Legal Business Name): NOWOKERE ESEMUEDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N WICKHAM RD SUITE 204
MELBOURNE FL
32935-8662
US

IV. Provider business mailing address

PO BOX 11406
BELFAST ME
04915-4005
US

V. Phone/Fax

Practice location:
  • Phone: 321-752-1540
  • Fax: 321-752-1558
Mailing address:
  • Phone: 321-752-1540
  • Fax: 321-752-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME111375
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: