Healthcare Provider Details

I. General information

NPI: 1073841086
Provider Name (Legal Business Name): EMMANUEL NOEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 E STATE ROAD 78
MOORE HAVEN FL
33471-8955
US

IV. Provider business mailing address

7285 NW 49TH CT
LAUDERHILL FL
33319-3446
US

V. Phone/Fax

Practice location:
  • Phone: 863-946-1600
  • Fax:
Mailing address:
  • Phone: 954-224-6568
  • Fax: 954-741-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN 284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: