Healthcare Provider Details

I. General information

NPI: 1598825366
Provider Name (Legal Business Name): MOURICE S NEMRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BATSON CT SUITE 106
NEW LENOX IL
60451-1564
US

IV. Provider business mailing address

100 BATSON CT SUITE 106
NEW LENOX IL
60451-1564
US

V. Phone/Fax

Practice location:
  • Phone: 815-463-9747
  • Fax: 815-463-9749
Mailing address:
  • Phone: 815-463-9747
  • Fax: 815-463-9749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036065703
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: